Tracheal sleeve pneumonectomy for non small cell lung cancer (NSCLC): short and long-term results in a single institution

OBJECTIVE: Bronchogenic carcinoma involving the carina or tracheobronchial angle still presents a challenge due to specific problems related to surgical technique and airway management. We reviewed our experience in carinal resection in terms of mortality, morbidity, and long-term survival. METHODS: Between 1982 and 2005, 49 patients underwent carinal resection: a right tracheal sleeve pneumonectomy was performed in 48 patients and a left tracheal sleeve pneumonectomy in 1 patient. Induction therapy was administered to 19 (39.6%) patients. In all cases, the anastomosis was performed with aid of high-frequency jet ventilation. RESULTS: Fourteen patients experienced perioperative complications (overall morbidity 28.6%), including 3 who died, for an overall mortality rate of 6.1%. Late empyema occurred in 5 (10.8%) patients. Histology was squamous cell carcinoma in 38 (77.6%) cases, adenocarcinoma in 10 (20.4%), and large-cell carcinoma in 1 (2%). The overall 5- and 10-year survival rates were 27.5 and 12.8%, respectively. Patients without nodal involvement had a significantly better prognosis than N1 and N2 patients (5-year survival: 56, 17, and 0%, respectively; p=0.002), as did patients with squamous histology compared to adenocarcinoma (5-year survival 29.5 and 11%, respectively; p=0.05). Multivariate analysis showed that nodal status was the only independent prognostic factor (p=0.00007). CONCLUSIONS: Tracheal sleeve pneumonectomy for bronchogenic carcinoma can be accomplished with acceptable mortality and morbidity, providing good long-term results. Nodal involvement seems to be an exclusion criterion for surgery, as it has a poor prognosis. Meticulous anesthetic management and surgical technique guarantee a better postoperative outcome.