Author of

• 20195

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  P3.16 - Surgery (ID 732)

  • Event: WCLC 2017
  • Type: Poster Session with Presenters Present
  • Track: Surgery
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)

  • 24266

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    P3.16-043 - Resection and Reconstruction of Tracheal Carina in Lung Cancer Surgery (ID 8966)

    09:30 - 09:30  |  Author(s): V. Shutov
    • Abstract

    Background:
    Resections of the tracheal carinal have a special place in thoracic surgery, which is determined by the anatomical arrangements in this area, technical difficulties associated with lung ventilation and airway reconstruction.
    
    Method:
    108 operations with carinal sleeve resection were perfomed from 1998 to 2016. Histopathologically : squamous cell carcinoma (80), adenocarcinoma (15), dimorphic cancer (2),, carcinoid (4), other forms (7). As for the stages of NSCLC the patients were distributed: IIА -7 (6,7%), IIB – 4 (3,8%), IIIA – 59 (56,2%), IIIB – 33 (31,4%), IV – 2 (1,9%).LN metastases were detected in 64 (61%) patients: N1 lesions in 17 patients, N2 in 45 patients, N3 in 2 patients. Direct invasion of metastatic LN into carina was detected in 13 patients (12%). All patients underwent mediastinal LN dissection, in 8 cases bilateral. Tracheobronchial anastomoses were formed by single nodal sutures using invagination technique,then were perfomed obligatory myoplasty of the anastomosis area.Pneumonectomy with carinal sleeve resection was performed in 82 patients (on the right 77, on the left 5). In 26 cases (24%), organ-preserving interventions were performed: isolated carinal resection or lob(bilob)ectomy with a double-sleeve reconstruction of the carina. In total, 7 different variants of reconstructions of the tracheal carina were performed. In 61 patients (56,5%), resection of other extra-pulmonary structures as simultaneously performed. 66 patients (61%) received combined treatment.
    
    Result:
    Postoperative complications occurred in 33% of patients (36), mortality was 10.2% (11). The causes of in-hospital mortality were tracheobronchial anastomotic leakage (5), pneumonia of the single lung (2), arrosive bleeding (1), PE (1), ADHF (1), ARDS (1). Mortality after organ-preserving resections was significantly lower in comparison with carinal pneumonectomy (7.5% vs 12.1%, p <0.05). Preservation of lung parenchyma ensured significantly better quality of life and early rehabilitation in comparison with patients who underwent carinal pneumonectomy. The overall 5-year survival rate was 28.5%, median survival was 24.2 + 2.3 months. In multivariate analysis, the most important prognostic factor was the status of the regional lymph nodes (N). In stages N0-N1, 5-year survival rate significantly prevailed over that in N2-N3 stages (35.1% vs 14.4%, p <0.05). Combined treatment compared with only surgical treatment allowed to improve 5-year results of treatment (38.5% vs. 18.1%, p <0.1).
    
    Conclusion:
    Surgery with carinal sleeve resection provide satisfactory results in the treatment of locally advanced lung cancer . Perfection of the technique of carinal "double-sleeve" resections with preservation of the lung parenchyma provides better results in comparison with carinal pneumonectomy.