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Thorac Cardiovasc Surg 2024; 72(03): 242-249
DOI: 10.1055/a-2199-2164
Original Thoracic

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

Dominik Herrmann
1   Department of Thoracic Surgery, Thoraxzentrum Ruhrgebiet, Herne, Germany
,
Urim Starova
1   Department of Thoracic Surgery, Thoraxzentrum Ruhrgebiet, Herne, Germany
,
Melanie Oggiano
1   Department of Thoracic Surgery, Thoraxzentrum Ruhrgebiet, Herne, Germany
,
Luiza Alexandra Luta
1   Department of Thoracic Surgery, Thoraxzentrum Ruhrgebiet, Herne, Germany
,
Shadi Hamouri 
2   Department of General Surgery and Urology, Jordan University of Science and Technology, Faculty of Medicine, Irbid, Jordan
,
Santiago Ewig
3   Department of Respiratory and Infectious Diseases, Thoraxzentrum Ruhrgebiet, Herne, Germany
,
Erich Hecker
1   Department of Thoracic Surgery, Thoraxzentrum Ruhrgebiet, Herne, Germany
,
Robert Scheubel
4   Clinic of Thoracic Surgery, Waldburg-Zeil Clinic, Wangen im Allgäu, Germany
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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

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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