Management and surgical resection for tumors of the trachea and carina: experience with 32 patients.

BACKGROUND: The purpose of the present study was to investigate the complications, long-term survival, and management lessons learned after surgical resection for patients with primary tumors of the trachea and carina and locally advanced lung cancer directly infiltrating the carina.
METHODS: A retrospective study was performed by our department on 32 patients undergoing surgical resection for primary tumors of the trachea and carina and locally advanced lung cancer directly infiltrating the carina between June 1986 and June 2003.
RESULTS: Various surgical modalities were performed according to the tumor location and extent: tracheal resection in 10 cases, carinal resection and reconstruction in 4 cases, carinal right upper lobectomy in 8 cases, carinal pneumonectomy in 4 cases, and partial tangential resection of the tracheal wall in 6 cases. Cardiopulmonary bypass was required in two patients for nearly complete obstruction of the trachea. Resected tumors included six distinct histologic types. Perioperative mortality was 9.4% (3/32). Major complications occurred in 31.3% (10/32) of the patients. The overall 1-, 3-, and 5-year survival rates were 87.5%, 56.3%, and 40.6%, respectively. Patients with primary tracheal and carinal tumors experienced a 5-year survival of 55.0% compared to 16.7% for those with locally advanced lung cancer directly infiltrating the carina (P < 0.05).
CONCLUSIONS: Surgical resection is the most effective treatment of choice for primary tumors of the trachea and carina. With careful patient selection and meticulous surgical and anesthesia techniques, the operative mortality and complications are acceptable, and long-term survival can be achieved.