Carinal Reconstruction for Lung Cancer and Airway Tumors: Long-term Results.

IF 3.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Annals of Thoracic Surgery Pub Date : 2024-10-22 DOI:10.1016/j.athoracsur.2024.10.005

Antonio D'Andrilli, Beatrice Trabalza Marinucci, Anna Maria Ciccone, Mohsen Ibrahim, Claudio Andreetti, Fabiana Messa, Giorgia Piccioni, Ilaria De Benedictis, Federico Venuta, Giulio Maurizi, Erino A Rendina

{"title":"Carinal Reconstruction for Lung Cancer and Airway Tumors: Long-term Results.","authors":"Antonio D'Andrilli, Beatrice Trabalza Marinucci, Anna Maria Ciccone, Mohsen Ibrahim, Claudio Andreetti, Fabiana Messa, Giorgia Piccioni, Ilaria De Benedictis, Federico Venuta, Giulio Maurizi, Erino A Rendina","doi":"10.1016/j.athoracsur.2024.10.005","DOIUrl":null,"url":null,"abstract":"Background: Resection and reconstruction of the carina infiltrated by non-small cell lung cancer (NSCLC) or an airway tumor is a technically demanding operation allowing oncologic radical treatment. Hereby we report the results of a 20-year experience from a high-volume center.Methods: Carinal resection was performed in 41 patients for NSCLC (n = 32) or primary airway tumor (n = 9). Right tracheal-sleeve pneumonectomy was performed in 19 patients, left tracheal-sleeve pneumonectomy in 6, isolated carinal resection in 4, and right tracheal-sleeve upper lobectomy in 12. Superior vena cava replacement was required in 8 patients. Extracorporeal membrane oxygenation was used in 4 patients undergoing isolated carinal reconstruction. Nine patients received neoadjuvant chemotherapy.Results: Complete resection (R0) was achieved in 97.5% of patients. Postoperative 30-day mortality was 7.3% (n = 3). The major complication rate was 24.3% (n = 10). There were 7 airway complications, consisting of 2 anastomotic fistulas and 5 anastomotic stenoses requiring dilatation and stenting; other major complications included 1 esophageal-pleural fistula, 1 pneumonia, and 1 pulmonary edema. Among the 32 NSCLC patients, 26 were pathologic stage III, and 6 were pathologic stage II. The recurrence rate was 34.2% (n = 13) and was 41.3% (n = 12) in NSCLC and 11.1% (n = 1) in airway tumors. The 3- and 5-year overall survival (Kaplan-Meier) was 56.1% (NSCLC, 50.8%; airway, 76.2%) and 50.5% (NSCLC, 44.5%; airway, 76.2%), respectively. Disease-free survival was 61.7% (NSCLC, 55.2%; airway, 85.7%) at 3 years and 55.5% (NSCLC, 48.3%; airway, 85.7%) at 5 years.Conclusions: Carinal reconstruction for lung and airway tumors resection is a complex, oncologically reliable procedure allowing good long-term results in adequately selected patients. Wherever possible, these operations should include parenchymal-sparing techniques allowing healthy lung tissue being spared without compromising the radicality of the resection.","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6000,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Thoracic Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.athoracsur.2024.10.005","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Resection and reconstruction of the carina infiltrated by non-small cell lung cancer (NSCLC) or an airway tumor is a technically demanding operation allowing oncologic radical treatment. Hereby we report the results of a 20-year experience from a high-volume center.

Methods: Carinal resection was performed in 41 patients for NSCLC (n = 32) or primary airway tumor (n = 9). Right tracheal-sleeve pneumonectomy was performed in 19 patients, left tracheal-sleeve pneumonectomy in 6, isolated carinal resection in 4, and right tracheal-sleeve upper lobectomy in 12. Superior vena cava replacement was required in 8 patients. Extracorporeal membrane oxygenation was used in 4 patients undergoing isolated carinal reconstruction. Nine patients received neoadjuvant chemotherapy.

Results: Complete resection (R0) was achieved in 97.5% of patients. Postoperative 30-day mortality was 7.3% (n = 3). The major complication rate was 24.3% (n = 10). There were 7 airway complications, consisting of 2 anastomotic fistulas and 5 anastomotic stenoses requiring dilatation and stenting; other major complications included 1 esophageal-pleural fistula, 1 pneumonia, and 1 pulmonary edema. Among the 32 NSCLC patients, 26 were pathologic stage III, and 6 were pathologic stage II. The recurrence rate was 34.2% (n = 13) and was 41.3% (n = 12) in NSCLC and 11.1% (n = 1) in airway tumors. The 3- and 5-year overall survival (Kaplan-Meier) was 56.1% (NSCLC, 50.8%; airway, 76.2%) and 50.5% (NSCLC, 44.5%; airway, 76.2%), respectively. Disease-free survival was 61.7% (NSCLC, 55.2%; airway, 85.7%) at 3 years and 55.5% (NSCLC, 48.3%; airway, 85.7%) at 5 years.

Conclusions: Carinal reconstruction for lung and airway tumors resection is a complex, oncologically reliable procedure allowing good long-term results in adequately selected patients. Wherever possible, these operations should include parenchymal-sparing techniques allowing healthy lung tissue being spared without compromising the radicality of the resection.

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

肺癌和气道肿瘤的气道重建：长期结果。

背景：非小细胞肺癌（NSCLC）或气道肿瘤浸润心窝的切除和重建是一项技术要求很高的手术，可进行肿瘤根治性治疗。在此，我们报告了一家大医院 20 年来的手术经验：方法：41 名患者因 NSCLC（32 人）或原发性气道肿瘤（9 人）接受了龋齿切除术。19名患者接受了右气管袖套式肺切除术，6名患者接受了左气管袖套式肺切除术，4名患者接受了孤立气管切除术，12名患者接受了右气管袖套式上叶切除术。8 名患者进行了上腔静脉置换术。4名接受孤立气管重建术的患者使用了体外膜肺氧合技术。9名患者接受了新辅助化疗：97.5%的患者实现了完全切除（R0）。术后30天死亡率为7.3%（3例）。主要并发症发生率为24.3%（10例）。气道并发症为7例（2例吻合口瘘，5例吻合口狭窄需要扩张和支架植入）；其他主要并发症包括1例食管胸膜瘘、1例肺炎和1例肺水肿。在32例NSCLC患者中，26例为病理Ⅲ期，6例为病理Ⅱ期。复发率为34.2%（13例）；NSCLC复发率为41.3%（12例），气道肿瘤复发率为11.1%（1例）。三年和五年总生存率（Kaplan-Meier）分别为56.1%（NSCLC：50.8%；气道：76.2%）和50.5%（NSCLC：44.5%；气道：76.2%）。3年无病生存率为61.7%（NSCLC：55.2%；气道：85.7%），5年无病生存率为55.5%（NSCLC：48.3%；气道：85.7%）：结论：肺部和气道肿瘤切除术后的椎管重建是一种复杂、肿瘤学上可靠的手术，经过适当选择的患者可获得良好的长期效果。在可能的情况下，这些手术应包括保留肺实质的技术，以便在不影响切除根治性的前提下保留健康的肺组织。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Annals of Thoracic Surgery 医学-呼吸系统

CiteScore

6.40

自引率

13.00%

发文量

1235

审稿时长

42 days

期刊介绍： The mission of The Annals of Thoracic Surgery is to promote scholarship in cardiothoracic surgery patient care, clinical practice, research, education, and policy. As the official journal of two of the largest American associations in its specialty, this leading monthly enjoys outstanding editorial leadership and maintains rigorous selection standards. The Annals of Thoracic Surgery features: • Full-length original articles on clinical advances, current surgical methods, and controversial topics and techniques • New Technology articles • Case reports • "How-to-do-it" features • Reviews of current literature • Supplements on symposia • Commentary pieces and correspondence • CME • Online-only case reports, "how-to-do-its", and images in cardiothoracic surgery. An authoritative, clinically oriented, comprehensive resource, The Annals of Thoracic Surgery is committed to providing a place for all thoracic surgeons to relate experiences which will help improve patient care.

期刊最新文献

Mechanisms of repair failure after mitral valve repair using chordal replacement. Contents Announcements Editorial Board Society Board