Carinal Resection and Reconstruction for Locally Advanced Primary Lung Cancer: Institutional Report

Carinal resection and reconstruction for lung cancer, termed carinaplasty, is a rare operation, and the procedure remains challenging and few reports have been presented. We analyzed complications, local control, and manner of recurrence in patients who underwent a carinaplasty and compared the results to those who underwent an ordinary bronchoplasty. Among 766 patients who underwent surgery for primary lung cancer at our institutions, 82 bronchoplasty procedures were performed, while 6 of those who received a bronchoplasty underwent a carinaplasty. Three of 6 patients who received a carinaplasty underwent the montage method, and other 3 patients underwent the one-stoma method. There were no operative deaths in patients who underwent a carinaplasty, while there was 1 operative death in the group of patients who underwent an ordinary bronchoplasty. Complications in the anastomotic site were observed in 33% in the carinaplasty group and 5.3% in the ordinary bronchoplasty group . There was no significant difference in regard to local recurrence between the groups . In conclusion, our results show that a carinaplasty is a technically demanding but useful procedure to avoid a pneumonectomy in patients with locally advanced lung cancer. 1. Introduction Carinal resection and reconstruction for lung cancer, termed carinaplasty, is a rare operation in the field of thoracic surgery. In Japan, only about 10 carinaplasty procedures are performed each year, while over 30,000 surgeries have been done annually for lung cancer in the past decade [1, 2]. The first carinaplasty procedure was reported by Barclay et al. [3] in 1957 for a lung tumor using an end-to-side anastomosis technique, the so-called montage method. Thereafter in 1966, Mathey et al. [4] reported the double-barrel technique. Presently, carinaplasty procedures are performed using 3 different techniques, the montage, double-barrel, and one-stoma methods. However, the procedure remains challenging and few reports have been presented. In this study, we analyzed complications, local control, and manner of recurrence in patients who underwent a carinaplasty and compared the results to those who underwent an ordinary bronchoplasty. 2. Subjects and Methods Patients with primary lung cancer who underwent a carinaplasty or ordinary bronchoplasty at our institutions from June 2002 to December 2012 were retrospectively investigated. Each one provided the consent to undergo the respective procedure. An affiliated ethics committee approved this retrospective study and waived the need for patient consent for analysis