Resection for bronchogenic carcinoma involving the carina: Long-term results and effect of nodal status on outcome

Objective: Bronchogenic carcinoma in close proximity to or involving the ca rina remains a challenging problem for thoracic surgeons. The operative pro cedures to allow complete resection are technically demanding and can be as sociated with significant morbidity and mortality. Little is known about lo ng-term survival data to guide therapy in these patients. Methods: We conducted a single-institution retrospective review. Results: We have performed 60 carinal resections for bronchogenic carcinoma : 18 isolated carinal resections for tumor confined to the carinal or proxi mal main stem bronchus; 35 carinal pneumonectomies; 5 carinal plus lobar re sections, and 2 carinal resections for stump recurrence after prior pneumon ectomy. Thirteen patients (22%) had a history of lung or airway surgery. Th e overall operative mortality was 15%, improved from the first half of the series (20%) to the second half (10%), and varied according to the type of resection performed. Adult respiratory distress syndrome was responsible fo r 5 early deaths, and all late deaths were related to anastomotic complicat ions. In 34 patients, all lymph nodes were negative for metastatic disease; 15 patients had positive N1 nodes, and 11 patients had positive N2/N3 node s. Complete follow-up was accomplished in 90%, with a mean follow-up of 59 months. The overall 5-year survival including operative mortality was 42%, with 19 absolute 5-year survivors. Survival was highest after isolated cari nal resection (51%). Lymph node involvement had a strong influence on survi val: patients without nodal involvement had a 5-year survival of 51%, compa red with 32% for patients with N1 disease and 12% for those with N2/N3 dise ase. Conclusions: This constitutes one of the largest single-institution reports on carinal resection for bronchogenic carcinoma involving the carina. Morb idity and mortality rates are acceptable. The overall survival including op erative mortality is 42%. Positive N2/N3 lymph nodes may be a contraindicat ion to surgery because of poor prognosis.