Complications of tracheal sleeve pneumonectomy: Personal experience and overview of the literature

Objectives: Tracheal sleeve pneumonectomy, although technically demanding, is considered the choice for tracheobronchial angle cancers. Complications in our 49 tracheal sleeve pneumonectomies are reviewed. Results, complicati ons, and technical aspects are critically discussed. Although series in the literature differ in selection of patients and surgical techniques and ext end over long periods, we attempt to compare our experience with results fr om the literature. Methods: From 1983 to September 1999, 60 patients eligible for tracheal sle eve pneumonectomy after conventional staging underwent operation. A Sybilla Fome-Cuf ventilation tube (Bivona, Inc, Gary, Ind) was used starting in 19 87 to facilitate anastomosis. Since 1993, all patients have undergone video -assisted thoracoscopy immediately before the operation. Results: There were 11 (18.3%) exploratory thoracotomies, 48 right tracheal sleeve pneumonectomies, and 1 left tracheal sleeve pneumonectomy. Among th e tracheal sleeve pneumonectomies, we recorded 4 (8.2%) perioperative death s (myocardial infarction, n = 1; heart failure, n = 1; pulmonary edema, n = I; gastric ulcer hemorrhage, n = 1; and anastomotic fistula in a patient w ho received high-dose radiation before the operation, n = 1). We observed 5 (10.2%) complications (lung edema, n = I; transitory recurrent nerve palsy , n = 2; empyema without fistula cured conservatively, n = 1; and pneumonia , n = I). Anastomotic stenosis did not occur. Twenty-six (53%) patients are alive 14 to 87 months postoperatively, 12 (24.5%) of these more than 5 yea rs postoperatively. Five (10.2%) died of mediastinal recurrence at 6 and 54 months. Two others (4.1%) died in road accidents. Conclusions: Tracheal sleeve pneumonectomy is a demanding operation with a high risk of complications. Analysis of literature and personal experience shows that complications can be greatly reduced through accurate selection of patients, precise technique, and optimal postoperative care. Long-term s urvival equals that obtained after standard pneumonectomy.