OPERATIVE APPROACHES FOR LEFT-SIDED CARINOPLASTY

Carinoplasty was performed in 42 patients: 7 with wedge pneumonectomy, 15 with sleeve pneumonectomy, 14 with one-stoma-type carinal reconstr uction, 5 with montage-type carinal reconstruction, and 1 other. Diagn oses in the 42 patients consisted of lung cancer in 31 (73.8%), tuberc ulous stenosis in 10 (23.8%), and tracheobronchial injury in 1 (2.4%). The thoracotomy was on the right side for lung cancer in 77.4% and on the left side for tuberculous stenosis in 80.0% (p < 0.01). Left-side d carinoplasty was performed in 14 patients using four approaches: mid line thoracotomy in 1, left thoracotomy in 10, midline sternotomy and left thoracotomy in 2, and bilateral thoracotomies in 1. Left wedge or sleeve pneumonectomy, without right thoracotomy, could be done by mid line sternotomy and left thoracotomy but with limited tracheal resecti on. Left one-stoma-type carinoplasty was undertaken, sacrificing one l obe, as an alternative to pneumonectomy, where an approach drawing the carina down to an aortopulmonary window was considered to be preferab le to the drawing-up approach.