Resection for tumors with carinal involvement: Technical aspects, results, and prognostic factors

Jean François Regnard, Cédric Perrotin, Riccardo Giovannetti, Olivier Schussler, Antonio Petino, Lorenzo Spaggiari, Marco Alifano, Pierre Magdeleinat

Research output: Contribution to journalArticle

Abstract

Background. Resection of tumors with carinal involvement remains a challenge because of specific problems of operative technique and airway management. We reviewed our experience with carinal resection and studied factors influencing postoperative course and long-term survival. Methods. Between 1983 and 2002, 65 patients underwent a carinal resection for non-small-cell lung cancers involving the carina (54 squamous cell carcinomas and 11 adenocarcinomas). Results. Fifty-eight right sleeve pneumonectomies and 2 left sleeve pneumonectomies were performed. In addition, five tracheocarinal resections with double bronchial reimplantation (no lung resection) were also performed. The intraoperative airway management consisted of high-frequency jet ventilation in 83% of patients and intermittent conventional ventilation through the operative field in the remaining 17% of patients. Operative mortality was 7.7%. Resection was complete in 61 patients. The overall 5-year and 10-year survival rates were 26.5% and 10.6%, respectively. Patients with N0 or N1 disease had a 5-year survival of 38% compared with 5.3% for those with N2 disease (p <0.01). At multivariate analysis only nodal status (N0, N1 versus N2; p = 0.0046) had a significant impact on long-term survival. Conclusions. Carinal resection provides acceptable results in terms of operative mortality and long-term survival rates. Patients should be carefully selected and probably enrolled in a multimodality treatment program in case of anticipated mediastinal lymph node involvement.

Original languageEnglish
Pages (from-to)1841-1846
Number of pages6
JournalAnnals of Thoracic Surgery
Volume80
Issue number5
DOIs
Publication statusPublished - Nov 2005

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Neoplasms
Airway Management
Pneumonectomy
Survival
Survival Rate
High-Frequency Jet Ventilation
Mortality
Replantation
Non-Small Cell Lung Carcinoma
Ventilation
Squamous Cell Carcinoma
Adenocarcinoma
Multivariate Analysis
Lymph Nodes
Lung
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Regnard, J. F., Perrotin, C., Giovannetti, R., Schussler, O., Petino, A., Spaggiari, L., ... Magdeleinat, P. (2005). Resection for tumors with carinal involvement: Technical aspects, results, and prognostic factors. Annals of Thoracic Surgery, 80(5), 1841-1846. https://doi.org/10.1016/j.athoracsur.2005.04.032

Resection for tumors with carinal involvement : Technical aspects, results, and prognostic factors. / Regnard, Jean François; Perrotin, Cédric; Giovannetti, Riccardo; Schussler, Olivier; Petino, Antonio; Spaggiari, Lorenzo; Alifano, Marco; Magdeleinat, Pierre.

In: Annals of Thoracic Surgery, Vol. 80, No. 5, 11.2005, p. 1841-1846.

Research output: Contribution to journalArticle

Regnard, JF, Perrotin, C, Giovannetti, R, Schussler, O, Petino, A, Spaggiari, L, Alifano, M & Magdeleinat, P 2005, 'Resection for tumors with carinal involvement: Technical aspects, results, and prognostic factors', Annals of Thoracic Surgery, vol. 80, no. 5, pp. 1841-1846. https://doi.org/10.1016/j.athoracsur.2005.04.032
Regnard, Jean François ; Perrotin, Cédric ; Giovannetti, Riccardo ; Schussler, Olivier ; Petino, Antonio ; Spaggiari, Lorenzo ; Alifano, Marco ; Magdeleinat, Pierre. / Resection for tumors with carinal involvement : Technical aspects, results, and prognostic factors. In: Annals of Thoracic Surgery. 2005 ; Vol. 80, No. 5. pp. 1841-1846.
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AU - Regnard, Jean François

AU - Perrotin, Cédric

AU - Giovannetti, Riccardo

AU - Schussler, Olivier

AU - Petino, Antonio

AU - Spaggiari, Lorenzo

AU - Alifano, Marco

AU - Magdeleinat, Pierre

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N2 - Background. Resection of tumors with carinal involvement remains a challenge because of specific problems of operative technique and airway management. We reviewed our experience with carinal resection and studied factors influencing postoperative course and long-term survival. Methods. Between 1983 and 2002, 65 patients underwent a carinal resection for non-small-cell lung cancers involving the carina (54 squamous cell carcinomas and 11 adenocarcinomas). Results. Fifty-eight right sleeve pneumonectomies and 2 left sleeve pneumonectomies were performed. In addition, five tracheocarinal resections with double bronchial reimplantation (no lung resection) were also performed. The intraoperative airway management consisted of high-frequency jet ventilation in 83% of patients and intermittent conventional ventilation through the operative field in the remaining 17% of patients. Operative mortality was 7.7%. Resection was complete in 61 patients. The overall 5-year and 10-year survival rates were 26.5% and 10.6%, respectively. Patients with N0 or N1 disease had a 5-year survival of 38% compared with 5.3% for those with N2 disease (p <0.01). At multivariate analysis only nodal status (N0, N1 versus N2; p = 0.0046) had a significant impact on long-term survival. Conclusions. Carinal resection provides acceptable results in terms of operative mortality and long-term survival rates. Patients should be carefully selected and probably enrolled in a multimodality treatment program in case of anticipated mediastinal lymph node involvement.

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