Challenges and outcomes in carinal resection and reconstruction for lung cancer

Résumé fourni par la source

Carinal resection and reconstruction is a complex procedure. It represents some of the most challenging techniques in thoracic surgery. Right carinal pneumonectomy and lobectomy are performed in less than 1% of patients with non-small-cell lung cancer. Methods: It’s a retrospective study including all patients who underwent sleeve pulmonary resection with carinal resection and reconstruction for lung cancer. between 2016 to 2024. Results: We collected 5 cases, all men. The mean age of the patients was 55 years. The symptomatology was dominated by hemoptysis (n=4). One patient presented chronic cough. Radiological findings showed suspicious mass in the right lung in all cases. Bronchoscopy revealed an endobronchial mass in 3 cases. The surgical approach was posterolateral thoracotomy in all cases. Four patients had lobectomy and one patient had pneumonectomy. The decision for carinal extension was driven by tumor infiltration (n=2) or lymphatic involvement (n=3). In four patients, a neocarina was formed. One patient had a wedge resection at the carina The average duration of the surgical procedure was 180min. the average duration of the chest drainage was 3 days [1-5]. Four patients had uneventful postoperative course. One patient developed a bronchial anastomotic complication on postoperative day 1, characterized by œdema at the bronchial sutures, leading to respiratory distress and subsequent death. Histopathological examination of the surgical specimen revealed clear bronchial resection margins in all patients. Conclusion: Carinal resection and reconstruction is technically demanding, particularly due to the caliber discrepancy. Yet, it remains feasible with an acceptable morbidity and mortality.

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