Methods: Between January 2002 and May 2011, 19 patients (18 males, 1 female; mean age 54.8±10.0 years; range 29 to 73 years) who underwent carinal resection and reconstruction due to carinal invasion were analyzed for operative technique, complications, operation indications and long-term follow-up. After resection of the trachea and bronchus, the left main bronchus is intubated across the operative field with a sterile spiral tube.

Results: Fourteen patients had non-small cell lung carcinoma (NSCLC), while three patients had adenoid cystic carcinoma including two with second primary carcinoma. The resections were as carinal sleeve pneumonectomy for 10 patients (two of them complementary pneumonectomy), lobectomy combined with carinal resection and reconstruction for eight patients, and isolated carinal resection and reconstruction through right posterolateral thoracotomy for one patient. A complete resection was performed in all patients except two undergoing surgery due to adenoid cystic carcinoma (complete resection rate: 89.4%). Surgical mortality and morbidity rates were 10.5% (n=2) and 26.3% (n=5), respectively. The mortality rate was indifferent between the resection types; however, patients undergoing carinal sleeve pneumonectomy had frequent complications, compared to the other patients (11.1% versus 40%). Three-year survival was 72.9% in patients with a mean follow-up of 45.4±37.6 months (median 34 months).

Conclusion: The carinal resection and reconstruction can be safely used in selected patients with an acceptable mortality, morbidity and good long-term follow-up outcomes.