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A Clinical Analysis Carina Resection and Reconstruction in Locally Advanced Nonsmall Cell Lung Cancer

Objective To investigate the indication of carina reconstruction surgery for locally advanced non-small cell lung cancer through analyzing the clinicopathological characteristics and prognosis of these patients.Methods Fifteen patients were involved in this retrospective analysis. One patient underwent carina resection and reconstruction, 6 patients underwent right pneumonectomy plus carina resection and reconstruction, 3 patients underwent right upper lobe and carina resection plus carina reconstruction, and 5 patients underwent left pneumonectomy plus carina resection and carina reconstruction. Kaplan-Meier method was used to calculate the survival rate, and Logrank test was used to compare the survival difference between groups. Results The mean duration time for operation was 410 min(261.3±81.6min). The number of resected mediastinal lymph nodes was 10.8±3.7. No perioperative death occurred. Two patients complicated with pneumonitis after surgery, both of them recovered through machine supported respiratory combined with antibiotics administering; 1 patient complicated with chylothorax and recovered through noninvasive procedure; 1 patient underwent thoracotomy exploration due to the persistant air leak and cured by suturing the air leaking lung tissue.The median survival time for whole group was 39 months, 3-year and 5-year survival rate were 52.5%，22.5%, respectively. The median survival time for the patients underwent right pneumonectomy was 12 months, compared 40 months with that of other patients. Conclusion Carina reconstruction is necessary for some patients with locally advanced nonsmall cell lung cancer with main bronchus or carina invasion, despite the sophisticated operation procedure and high morbidity rate. While the right pneumonectomy plus carinal reconstruction should be avoided due to the poor prognosis.