Left Sleeve Pneumonectomy – a Series of Cases

Cordos Ioan, Orghidan George Mihnea, Paleru Cristian, Stoica Radu, Fotache Georgiana

Marius Nasta Institute of Pneumology, Bucharest, Romania

Date, time and location: 2018.05.26 08:30, Congress Hall, 2F–C

Abstract

Introduction:

One of the most demanding technical procedures of thoracic surgery remains the left carinal pneumonectomy and reconstruction. The anatomy of the right upper lobe and the shorter length of the main stem bronchus require carinal resections for most right-sided tumors. Left carinal pneumonectomies, comparatively more challenging, require exposing the lower trachea and the left main stem bronchus; which is covered by the aortic arch.

Objective:

This study focuses on a sample of three patients, within our department, who underwent left carinal pneumonectomy by left thoracotomy. These patients were evaluated retrospectively based upon clinical features, surgical technique and risk of complication.

Methods:

Of the three cases, one was a female and two were male, with the median age between 52 and 73. The etiology of the resection was adenoid cystic carcinoma as well as squamous cell carcinoma. Two lateral left thoracotomies and one left posterolateral thoracotomy were performed. In all of the cases, jet ventilation through the incision was utilized.

Results:

All of the patients survived, with no mortality, and without major surgical-related complication. Additionally, air lumen was good in all the patients.

Conclusion:

The left carinal pneumonectomy and reconstruction, a demanding surgical procedure, can be performed using the left thoracic approach if the following apply: no vascular stumps exist outside the pericardium, a complete lymphadenectomy is performed along with blunt dissection of the pretracheal avascular space (the reversed pathway of the mediastinoscopy dissection).