Filiz KOŞAR, Muzaffer METİN, Adalet DEMİR, Sadettin ÇIKRIKÇIOĞLU, Mehmet Zeki GÜNLÜOĞLU, Mehmet Akif ÖZGÜL, Adnen SAYAR, Necati ÇITAL, Songül BÜYÜKKALE, Serda KANBUR, Levent DALAR, Atilla GÜRSES

Sleeve karinal rezeksiyon ve rekonstrüksiyon: Malign tümörlerin karinal invazyonunun cerrahi endikasyonu ve sonuçları

Amaç: Bu çalışmada karinal invazyon nedeni ile karinal rezeksiyon ve rekonstrüksiyon uyguladığımız malign tümörlü hastaların klinik sonuçları incelendi. Çalışma planı: Ocak 2002 - Mayıs 2011 tarihleri arasında karinal invazyon nedeni ile karinal rezeksiyon ve rekonstrüksiyon uygulanan malign tümörlü 19 hasta (18 erkek, 1 kadın; ort. yaş 54.8±10.0 yıl; dağılım 29-73 yıl) ameliyat tekniği, komplikasyon, ameliyat endikasyonları ve uzun dönem takipleri açısından incelendi. Trakea ve bronş rezeksiyonu sonrası, sol ana bronş, ameliyat sahasına alınan steril spiralli entübasyon tüpü ile entübe edildi.Bulgular: İkisi ikinci primer olmak üzere, 14 hastada küçük hücreli dışı akciğer karsinomu (KHDAK), üç hastada adenoid kistik karsinom vardı. On hastaya karinal sleeve pnömonektomi (ikisi tamamlayıcı olmak üzere), sekiz hastaya lobektomi ile kombine karina rezeksiyonu ve rekonstrüksiyonu ve bir hastaya izole karina rezeksiyonu ve rekonstrüksiyonu sağ posterolateral torakotomi ile uygulandı. Adenoid kistik karsinom nedeni ile ameliyat edilen iki hasta dışında tüm hastalarda komplet rezeksiyon yapıldı (komplet rezeksiyon oranı: %89.4). Cerrahi mortalite ve morbidite oranı sırası ile %10.5 (n=2) ve %26.3 (n=5) idi. Mortalite oranı açısından rezeksiyon tipleri arasında fark yok iken, karinal sleeve pnömonektomi uygulanan hastalarda, diğer hastalara kıyasla, daha fazla komplikasyon (%40’a kıyasla %11.1) geliştiği saptandı. Ortalama 45.4±37.6 ay (medyan 34 ay) takip edilen hastaların üç yıllık sağkalımı %72.9 idi.Sonuç: Karinal rezeksiyon ve rekonstrüksiyon, seçilmiş hastalarda kabul edilebilir mortalite, morbidite ve iyi uzun dönem takip sonuçları ile güvenle uygulanabilir.

Sleeve carinal resection and reconstruction: surgical indication and results of carinal invasion by malignant tumors

Background: This study aims to analyze the clinical outcomes of patients with malignant tumors after carinal resection and reconstruction due to carinal invasion. Methods: Between January 2002 and May 2011, 19 patients (18 males, 1 female; mean age 54.8±10.0 years; range 29 to 73 years) who underwent carinal resection and reconstruction due to carinal invasion were analyzed for operative technique, complications, operation indications and long-term follow-up. After resection of the trachea and bronchus, the left main bronchus is intubated across the operative field with a sterile spiral tube.Results: Fourteen patients had non-small cell lung carcinoma (NSCLC), while three patients had adenoid cystic carcinoma including two with second primary carcinoma. The resections were as carinal sleeve pneumonectomy for 10 patients (two of them complementary pneumonectomy), lobectomy combined with carinal resection and reconstruction for eight patients, and isolated carinal resection and reconstruction through right posterolateral thoracotomy for one patient. A complete resection was performed in all patients except two undergoing surgery due to adenoid cystic carcinoma (complete resection rate: 89.4%). Surgical mortality and morbidity rates were 10.5% (n=2) and 26.3% (n=5), respectively. The mortality rate was indifferent between the resection types; however, patients undergoing carinal sleeve pneumonectomy had frequent complications, compared to the other patients (11.1% versus 40%). Three-year survival was 72.9% in patients with a mean follow-up of 45.4±37.6 months (median 34 months).Conclusion: The carinal resection and reconstruction can be safely used in selected patients with an acceptable mortality, morbidity and good long-term follow-up outcomes.

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