Background Carinal sleeve resection with pneumonectomy is one of the rarest procedures in thoracic surgery, but for locally advanced central lung cancer with infiltration of the carina, it is an option to achieve complete resection. Additionally, it might be the method of choice for patients with stump insufficiency after pneumonectomy or in the cases with anastomosis dehiscence after sleeve lobectomy. The aim of this study was to evaluate the morbidity and long-term survival of patients with non-small-cell lung cancer (NSCLC) who underwent sleeve pneumonectomy, either for curative intent or as an option to treat postoperative complications. Methods All consecutive patients with NSCLC who underwent carinal sleeve pneumonectomy for the aforementioned indications in our department between December 2021 and September 2003 were included in this study. An analysis of demographic characteristics, perioperative variables, and long-term survival was carried out. Data were evaluated retrospectively. Results Fifty patients underwent pneumonectomy with carina sleeve resection. Thirty-one cases for curative treatment of NSCLC (primary sleeve pneumonectomy [pSP]) and 19 patients were treated because of postpneumonectomy bronchial stump insufficiency or bronchial anastomosis dehiscence (secondary sleeve pneumonectomy [sSP]). Complications occurred in 30 patients (60%) and the 90-day mortality was 18% (n = 9). Patients with pSP had an estimated overall survival of 39.6 months, compared to estimated overall survival for patients after sSP of 24.5 months (p = 0.01). The N status did not appear to affect outcomes. Conclusion Carinal sleeve resection with pneumonectomy is a feasible procedure with limited morbidity and mortality. This procedure is a reasonable therapeutic option for patients with locally advanced central NSCLC after mandatory patient selection.

中文翻译：

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非小细胞肺癌患者的肺切除术和隆突袖切除术

背景 隆突袖式全肺切除术是胸外科中最罕见的手术方式之一，但对于局部进展期中央型肺癌伴隆突浸润，是实现完全切除的一种选择。此外，对于全肺切除术后残肢不全的患者或袖状肺叶切除术后吻合口裂开的患者，它可能是一种选择的方法。本研究的目的是评估接受袖状全肺切除术的非小细胞肺癌 (NSCLC) 患者的发病率和长期生存率，无论是出于治疗目的还是作为治疗术后并发症的一种选择。方法 2021年12月至2003年9月期间在我科因上述适应症接受隆突袖式全肺切除术的所有连续NSCLC患者纳入本研究。对人口特征、围手术期变量和长期生存进行了分析。数据进行回顾性评估。结果 50 例患者接受了全肺切除加隆凸袖状切除术。31例治愈性治疗NSCLC（一期袖状全肺切除术[pSP]），19例因全肺切除后支气管残端闭合不全或支气管吻合口裂开而接受治疗（二期袖状全肺切除术[sSP]）。30 名患者 (60%) 出现并发症，90 天死亡率为 18% (n = 9)。pSP 患者的估计总生存期为 39.6 个月，而 sSP 患者的估计总生存期为 24.5 个月 (p = 0.01)。N 状态似乎不会影响结果。结论 隆凸袖状全肺切除术是一种可行的手术，其发病率和死亡率有限。对于强制性患者选择后的局部晚期中心性非小细胞肺癌患者来说，该手术是一种合理的治疗选择。