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J Thorac Cardiovasc Surg 2006;131:81-89
© 2006 The American Association for Thoracic Surgery

General Thoracic Surgery

Long-term results after carinal resection for carcinoma: Does the benefit warrant the risk?

Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Centre Chirurgical Marie-Lannelongue, Le Plessis-Robinson, France.

Read at the Eighty-fifth Annual Meeting of The American Association for Thoracic Surgery, San Francisco, Calif, April 10-13, 2005.

Received for publication April 14, 2005; revisions received July 10, 2005; accepted for publication July 19, 2005.

^_* Address for reprints: Philippe Dartevelle, MD, Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Centre Chirurgical Marie-Lannelongue, 133 Avenue de la Resistance, 92350 Le Plessis-Robinson, France.

OBJECTIVE: We sought to determine whether the benefit warrants the risk in patients undergoing carinal resection for carcinoma.

METHODS: This was a retrospective single-center study.

RESULTS: Between June 1981 and August 2004, 119 patients underwent carinal resection for carcinoma in our institution. Carinal pneumonectomy was performed in 103 cases (96 right and 7 left pneumonectomies), carinal resection plus right upper lobectomy in 3, carinal resection after left pneumonectomy in 2, and carinal resection without pulmonary resection in 11. Superior vena caval resection was combined with carinal pneumonectomy in 25 patients with bronchogenic carcinoma (13 patients had complete superior vena caval resection with graft interposition). Nine (7.6%) patients died in the hospital or within 30 days of the operation. Follow-up was complete for 117 (98%) patients up to August 2004 or to the date of death. The 5- and 10-year survivals were 44% and 25%, respectively, for patients with bronchogenic carcinoma (n = 100). However, survival was significantly better in patients with N0 or N1 disease (n = 73) than in those with N2 or N3 disease (n = 27; 53% vs 15% at 5 years, respectively). The 5- and 10-year survivals in the remaining 19 patients reached 66% and 48%, respectively, and were best in patients with neuroendocrine carcinoma (100% survival at 10 years) and adenoid cystic carcinoma (69% survival at 10 years).

CONCLUSIONS: Surgical intervention for carcinoma involving the carina is feasible, with acceptable mortality and good long-term survival in selected patients. The presence of positive N2 disease should, however, be considered a potential contraindication to carinal resection in patients with bronchogenic carcinoma because of the poor long-term survival.

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