Pneumonectomy with Carinal Sleeve Resection in Patients with Non-Small-Cell Lung Cancer

Abstract

Background Carinal sleeve resection with pneumonectomy is one of the rarest procedures in thoracic surgery, but for locally advanced central lung cancer with infiltration of the carina, it is an option to achieve complete resection. Additionally, it might be the method of choice for patients with stump insufficiency after pneumonectomy or in the cases with anastomosis dehiscence after sleeve lobectomy. The aim of this study was to evaluate the morbidity and long-term survival of patients with non-small-cell lung cancer (NSCLC) who underwent sleeve pneumonectomy, either for curative intent or as an option to treat postoperative complications.

Methods All consecutive patients with NSCLC who underwent carinal sleeve pneumonectomy for the aforementioned indications in our department between December 2021 and September 2003 were included in this study. An analysis of demographic characteristics, perioperative variables, and long-term survival was carried out. Data were evaluated retrospectively.

Results Fifty patients underwent pneumonectomy with carina sleeve resection. Thirty-one cases for curative treatment of NSCLC (primary sleeve pneumonectomy [pSP]) and 19 patients were treated because of postpneumonectomy bronchial stump insufficiency or bronchial anastomosis dehiscence (secondary sleeve pneumonectomy [sSP]). Complications occurred in 30 patients (60%) and the 90-day mortality was 18% (n = 9). Patients with pSP had an estimated overall survival of 39.6 months, compared to estimated overall survival for patients after sSP of 24.5 months (p = 0.01). The N status did not appear to affect outcomes.

Conclusion Carinal sleeve resection with pneumonectomy is a feasible procedure with limited morbidity and mortality. This procedure is a reasonable therapeutic option for patients with locally advanced central NSCLC after mandatory patient selection.

Keywords

sleeve pneumonectomy - carinal resection - non-small-cell lung cancer - trachea

Publication History

Received: 30 June 2023

Accepted: 24 October 2023

Accepted Manuscript online:
26 October 2023

Article published online:
06 December 2023

• References

• 1 Postmus PE, Kerr KM, Oudkerk M. et al; ESMO Guidelines Committee. Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2017; 28 (Suppl. 04) iv1-iv21
• 2 Galetta D, Spaggiari L. Early and long-term results of tracheal sleeve pneumonectomy for lung cancer after induction therapy. Ann Thorac Surg 2018; 105 (04) 1017-1023
• 3 Herrmann D, Oggiano M, Gencheva-Bozhkova P. et al. Carinal sleeve resection: last exit for bronchial insufficiency-a 17-year, single-centre experience. Interact Cardiovasc Thorac Surg 2021; 32 (06) 921-927
• 4 End A, Hollaus P, Pentsch A. et al. Bronchoplastic procedures in malignant and nonmalignant disease: multivariable analysis of 144 cases. J Thorac Cardiovasc Surg 2000; 120 (01) 119-127
• 5 Eichhorn F, Storz K, Hoffmann H, Muley T, Dienemann H. Sleeve pneumonectomy for central non-small cell lung cancer: indications, complications, and survival. Ann Thorac Surg 2013; 96 (01) 253-258
• 6 Sezen CB, Kocaturk CI, Bilen S. et al. Long-term outcomes of carinal sleeve resection in non-small cell lung cancer. Thorac Cardiovasc Surg 2020; 68 (02) 190-198
• 7 Tapias L, Lanuti M. Carinal resections. Ann Cardiothorac Surg 2018; 7 (02) 309-313
• 8 Petrella F, Salvi L, Venturino M, Alamanni F, Spaggiari L. Veno-venous extracorporal membrane oxygenation tracheal sleeve pneumonectomy. Shanghai Chest 2020; 4: 7
• 9 Gonzalez-Rivas D, Soultanis KM, Garcia A. et al. Uniportal video-assisted thoracoscopic lung sparing tracheo-bronchial and carinal sleeve resections. J Thorac Dis 2020; 12 (10) 6198-6209
• 10 Deslauriers J, Grégoire J, Jacques LF, Piraux M. Sleeve pneumonectomy. Thorac Surg Clin 2004; 14 (02) 183-190
• 11 Ludwig C, Riedel R, Schnell J, Stoelben E. Inhalation with Tobramycin to improve healing of tracheobronchial reconstruction. Eur J Cardiothorac Surg 2009; 35 (05) 797-800 , discussion 800
• 12 Ludwig C, Stoelben E. A new classification of bronchial anastomosis after sleeve lobectomy. J Thorac Cardiovasc Surg 2012; 144 (04) 808-812
• 13 Goldstraw P, Crowley J, Chansky K. et al; International Association for the Study of Lung Cancer International Staging Committee, Participating Institutions. The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classification of malignant tumours. J Thorac Oncol 2007; 2 (08) 706-714
• 14 de Perrot M, Fadel E, Mercier O, Mussot S, Chapelier A, Dartevelle P. Long-term results after carinal resection for carcinoma: does the benefit warrant the risk?. J Thorac Cardiovasc Surg 2006; 131 (01) 81-89
• 15 Deslauriers J, Grégoire J, Jacques LF, Piraux M, Guojin L, Lacasse Y. Sleeve lobectomy versus pneumonectomy for lung cancer: a comparative analysis of survival and sites or recurrences. Ann Thorac Surg 2004; 77 (04) 1152-1156 , discussion 1156
• 16 Jungraithmayr W, Hasse J, Olschewski M, Stoelben E. Indications and results of completion pneumonectomy. Eur J Cardiothorac Surg 2004; 26 (01) 189-196
• 17 Rea F, Marulli G, Schiavon M. et al. Tracheal sleeve pneumonectomy for non small cell lung cancer (NSCLC): short and long-term results in a single institution. Lung Cancer 2008; 61 (02) 202-208
• 18 Mansour Z, Kochetkova EA, Santelmo N. et al. Persistent N2 disease after induction therapy does not jeopardize early and medium term outcomes of pneumonectomy. Ann Thorac Surg 2008; 86 (01) 228-233
• 19 Porhanov VA, Poliakov IS, Selvaschuk AP. et al. Indications and results of sleeve carinal resection. Eur J Cardiothorac Surg 2002; 22 (05) 685-694
• 20 Cuthbertson BH, Elders A, Hall S. et al; Scottish Critical Care Trials Group, Scottish Intensive Care Society Audit Group. Mortality and quality of life in the five years after severe sepsis. Crit Care 2013; 17 (02) R70
• 21 Braun M, Herrmann D, Oggiano M, Luta LA, Hecker E. Evaluation of mortality in elective pneumonectomy in lung cancer after preoperative risk stratification. Zentralbl Chir 2022; 147: S54-S55
• 22 Faivre-Finn C, Vicente D, Kurata T. et al. Four-year survival with durvalumab after chemoradiotherapy in stage III NSCLC-an update from the PACIFIC trail. J Thorac Oncol 2021; 16 (05) 860-867
• 23 Roviaro G, Vergani C, Maciocco M, Varoli F, Francese M, Despini L. Tracheal sleeve pneumonectomy: long-term outcome. Lung Cancer 2006; 52 (01) 105-110