Original article
General thoracic
Video-Assisted Thoracic Surgery Resection and Reconstruction of Carina and Trachea for Malignant or Benign Disease in 12 Patients: Three Centers’ Experience in China

https://doi.org/10.1016/j.athoracsur.2016.01.080Get rights and content

Background

Although video-assisted thoracoscopic surgery (VATS) has been widely applied to both peripheral and central lung cancer treatment in many centers, there is great hesitation to adopt it for carinal or tracheal surgical procedures. The aims of this study were to explore the feasibility of VATS in the treatment of benign and malignant diseases involving the carina and trachea and to highlight relevant techniques.

Methods

Patients undergoing VATS carinal or tracheal procedures between May 2012 and July 2015 from three centers in China were included in this study. Their clinical characteristics, operative details, and postoperative course were analyzed.

Results

Twelve patients underwent five different types of VATS airway reconstructions with or without lobectomy: including right bronchial resection with partial carinal reconstruction (3 patients), tracheal resection and reconstruction (4 patients), tracheal or right bronchial resection with carinal reconstruction (3 patients), left bronchial resection with carinal reconstruction (1 patient), and right pneumonectomy with carinal reconstruction (1 patient). Complete resection was achieved in all patients. The mean operative time was 224 ± 78 minutes, and the median time of the first anastomosis was 41 minutes (range, 15 to 60 minutes), regardless of whether the reconstruction was a tracheal or carinal. The median estimated blood loss was 100 mL (range 10 to 1000 mL). The mean postoperative hospital stay was 12.5 ± 2.5 days. There was no perioperative mortality or major morbidity. Median duration of follow-up was 12 months (range 5 to 43 months).

Conclusions

VATS resection and reconstruction of the carina or trachea are feasible, and these procedures can be safely performed using the techniques described. We believe, with the accumulation of VATS experience, these procedures could be adopted as routine approaches in tracheal surgery.

Section snippets

Study Population

The medical ethics boards of all participating hospitals approved this study. Between May 2012 and July 2015, 12 patients underwent VATS carinal or tracheal resection and reconstruction for benign or malignant diseases at the First Affiliated Hospital of Guangzhou Medical University (Guangzhou, China) (patients 1 to 9), the Affiliated Hospital of Qingdao University (Qingdao, China) (patients 10 and 11), and the Affiliated Union Hospital of Fujian Medical University (Fuzhou, China) (patient 12).

Results

The 12 patients (5 men and 7 women) had a mean age of 52 ± 8 years. The preoperative forced expiratory volume was 1.67 ± 0.74 L, with a mean percentage of predicted value of 62.3 ± 29.0%. The mean percentage of predicted diffusion capacity for carbon monoxide of the lung was 85.7 ± 9.0%. The underlying disorders were squamous cell carcinoma (3 patients), mucoepidermoid carcinoma (2 patients), adenoid cystic carcinoma (2 patients), endobronchial tuberculosis (2 patients), atypical carcinoid

Comment

We shared our experience of performing VATS tracheal or carinal resection and reconstructions in a variety of situations. In this series, no in-hospital mortality or major morbidity occurred. This finding compared favorably with previously reported postoperative mortality rates after open thoracotomy, which ranged from 2.4% to 12.7% 4, 5, 6. Although the median follow-up was only 12 months, the first patient in this series remained well at 43 months.

We believe that the favorable outcome is

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Drs Li, Wang, and Jiang contributed equally to this work.

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