Gökhan ARSLAN, Hakan BOZCUK, Necdet ÖZ, Abid DEMİRCAN, Alpay SAPER, Tülin Aydoğdu TİTİZ

Akciğer kanserinde karinal sleeve lobektomi ve sleeve pnömonektomi sonuçları

Amaç: Bu çalışmada karina invazyonu olan küçük hücreli dışı akciğer kanserlerinde uyguladığımız cerrahi yöntemler ve tedavi sonuçları sunuldu.Çalışma planı: Haziran 2002 - Mart 2009 tarihleri arasında kliniğimizde karina rezeksiyonu uygulanan küçük hücreli dışı akciğer kanserli (11 yassı epitel hücreli karsinom, 2 adenokarsinom, 1 adenoskuamöz karsinom, 1 dev hücreli karsinom) 15 hasta (13 erkek, 2 kadın; ort. yaş 56.7 yıl; dağılım 36-68 yıl) çalışmaya dahil edildi. Ameliyat öncesi evrelemeye göre hastaların hiçbirinde mediyastinal lenf nodu tutulumu yoktu. On bir hastaya karinal sleeve pnömonektomi (10 sağ, 1 sol), dört hastaya karinal sleeve sağ üst lobektomi yapıldı. Tüm hastalara cerrahi yaklaşım lateral torakotomi idi. Karina rezeksiyonuna ek olarak bir hastaya kısmi vena kava superiyor rezeksiyonu, iki hastaya kısmi perikard rezeksiyonu ve bir hastaya da metastaz nedeni ile adrenalektomi uygulandı.Bulgular: Ameliyata bağlı mortalite ve morbidite sırasıyla %6.6 (n=1) ve %33.3 (n=5) oldu. En sık görülen komplikasyon uzamış hava kaçağı ve ampiyem idi. Ameliyat sonrası dört hastada N2, beş hastada ise N1 nodül tespit edildi. Ortalama nükssüz sağkalım süresi %95 güven aralığında 40 ay (dağılım 17.2-63.2) olur iken medyan nükssüz sağkalım süresi 12.2 ay (dağılım 9-15.4) oldu.Sonuç: Karinayı tutan akciğer kanserli iyi seçilmiş hastalarda cerrahi tedavi ile kabul edilebilir mortalite ve iyi bir sağkalım olasıdır.

Results of carinal sleeve lobectomy and sleeve pneumonectomy for lung carcin

Background: This study presents our surgical procedure and results of treatment for nonsmall cell lung cancer invading the carina.Methods: Between June 2002 and March 2009 in our clinic, 15 patients (13 males, 2 females; mean age 56.7 years; range 36 to 68 years) who underwent carinal resection for non-small cell lung cancers (11 squamous cell carcinomas, 2 adenocarcinomas, 1 adenosquamous carcinoma and 1 giant cell carcinoma) were included in this study. According to preoperative staging, there was no mediastinal lymph node involvement in all patients. Eleven patients underwent carinal pneumonectomies (10 rights, 1 left), and four patients had carinal right upper lobectomies performed. The operative approach was lateral thoracotomy in all patients. In addition to carinal resection one underwent partial resection of the vena cava superior, two partial pericardial resection and one patient underwent adrenalectomy for the metastases.Results: Operative mortality and morbidity were 6.6% (n=1) and 33.3% (n=5), respectively. The most common complications were prolonged air leak and empyema. Four patients had positive N2 nodes, and five patients had positive N1 nodes postoperatively. Mean recurrence free survival period was 40 months (95% CI: 17.2-63.2) and median recurrence free survival period was 12.2 month (95% CI: 9-15,4; CI: confidence interval).Conclusion: Surgical intervention for carcinoma involving the carina is feasible, with acceptable mortality and good survival in selected patients.

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1) Mitchell JD, Mathisen DJ, Wright CD, Wain JC, Donahue DM, Moncure AC, et al. Clinical experience with carinal resection. J Thorac Cardiovasc Surg 1999;117:39-52.
2) Mitchell JD, Mathisen DJ, Wright CD, Wain JC, Donahue DM, Allan JS, et al. Resection for bronchogenic carcinoma involving the carina: long-term results and effect of nodal status on outcome. J Thorac Cardiovasc Surg 2001;121:465 71.
3) de Perrot M, Fadel E, Mercier O, Mussot S, Chapelier A, Dartevelle P. Long term results after carinal resection for carcinoma: does the benefit warrant the risk? J Thorac Cardiovasc Surg 2006;131:81-9.
4) Jalal A, Jeyasingham K. Bronchoplasty for malignant and benign conditions: a retrospective study of 44 cases. Eur J Cardiothorac Surg 2000;17:370-6.
5) Regnard JF, Perrotin C, Giovannetti R, Schussler O, Petino A, Spaggiari L, et al. Resection for tumors with carinal involvement: technical aspects, results, and prognostic factors. Ann Thorac Surg 2005;80:1841-6.
6) Macchiarini P, Altmayer M, Go T, Walles T, Schulze K, Wildfang I, et al. Technical innovations of carinal resection for nonsmall-cell lung cancer. Ann Thorac Surg 2006; 82:1989-97.
7) Porhanov VA, Poliakov IS, Selvaschuk AP, Grechishkin AI, Sitnik SD, Nikolaev IF, et al. Indications and results of sleeve carinal resection. Eur J Cardiothorac Surg 2002;22:685-94.
8) Yamamoto K, Miyamoto Y, Ohsumi A, Imanishi N, Kojima F. Surgical results of carinal reconstruction: an alterative technique for tumors involving the tracheal carina. Ann Thorac Surg 2007;84:216-20.
9) Tokat AO, Özkan M, Güngör A. Akciğer kanseri sebebiyle kombine trakeal sleeve pnömonektomi, vena cava superior rezeksiyonu ve rekonstrüksiyonu: Olgu sunumu. T Klin J Med Sci 2004;24:295-8.
10) Farjah F, Wood DE, Varghese TK Jr, Symons RG, Flum DR. Trends in the operative management and outcomes of T4 lung cancer. Ann Thorac Surg 2008;86:368-74.
11) Deslauriers J, Grégoire J, Jacques LF, Piraux M, Guojin L, Lacasse Y. Sleeve lobectomy versus pneumonectomy for lung cancer: a comparative analysis of survival and sites or recurrences. Ann Thorac Surg 2004;77:1152-6.
12) Ferguson MK, Karrison T. Does pneumonectomy for lung cancer adversely influence long-term survival? J Thorac Cardiovasc Surg 2000;119:440-8.
13) Martin J, Ginsberg RJ, Abolhoda A, Bains MS, Downey RJ, Korst RJ, et al. Morbidity and mortality after neoadjuvant therapy for lung cancer: the risks of right pneumonectomy. Ann Thorac Surg 2001;72:1149-54.
14) Keller SM, Vangel MG, Wagner H, Schiller JH, Herskovic A, Komaki R, et al. Prolonged survival in patients with resected non-small cell lung cancer and single-level N2 disease. J Thorac Cardiovasc Surg 2004;128:130-7.
15) Barclay RS, McSwan N, Welsh TM. Tracheal reconstruction without the use of grafts. Thorax 1957;12:177-80.