Subscribe to RSS
DOI: 10.1055/a-2240-9974
Resektionen der Trachealbifurkation
Carinal ResectionsZusammenfassung
Die Bifurkationsresektion wird in der Literatur übereinstimmend als einer der anspruchsvollsten thoraxchirurgischen Eingriffe beschrieben. Unter diesem Begriff werden verschiedene Eingriffe zusammengefasst, die abhängig von der zugrunde liegenden Erkrankung und ihrer Ausdehnung unterschiedliche Resektionsformen und Rekonstruktionstechniken erfordern. Aus chirurgischer Sicht sind vor allem die engen anatomischen Verhältnisse und die Technik der Rekonstruktion der zentralen Atemwege herausfordernd. Ein komplexes Atemwegsmanagement und eine aufwendige postoperative Nachsorge zeigen jedoch, dass diese Eingriffe über die chirurgische Expertise hinaus, die Leistung eines multidisziplinären Teams darstellen. Dieser Artikel widmet sich den wichtigsten prä-, intra- und postoperativen Aspekten dieser Eingriffe.
Abstract
Carinal resections are consistently described in the literature as one of the most challenging procedures in thoracic surgery. Depending on the underlying disease and its extent, different resection forms and reconstruction techniques are required. From a surgical point of view, the complex anatomy, and the technique of reconstruction of the central airway are particularly challenging. However, complex airway management and extensive postoperative follow-up demonstrate that these procedures require a multidisciplinary team effort beyond surgical expertise. This article reviews the most important pre-, intra-, and post-operative aspects of these challenging procedures.
Publication History
Received: 08 October 2023
Accepted after revision: 21 December 2023
Article published online:
15 February 2024
© 2024. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
Literatur
- 1 Grillo HC. Carinal reconstruction. Ann Thorac Surg 1982; 34: 356-373 DOI: 10.1016/s0003-4975(10)61394-x. (PMID: 7138104)
- 2 de Perrot M, Fadel E, Mercier O. et al. Long-term results after carinal resection for carcinoma: does the benefit warrant the risk?. J Thorac Cardiovasc Surg 2006; 131: 81-89 DOI: 10.1016/j.jtcvs.2005.07.062.
- 3 Jensik RJ, Faber LP, Kittle CF. et al. Survival in patients undergoing tracheal sleeve pneumonectomy for bronchogenic carcinoma. J Thorac Cardiovasc Surg 1982; 84: 489-496 (PMID: 7121039)
- 4 Porhanov VA, Poliakov IS, Selvaschuk AP. et al. Indications and results of sleeve carinal resection. Eur J Cardiothorac Surg 2002; 22: 685-694 DOI: 10.1016/s1010-7940(02)00523-7. (PMID: 12414031)
- 5 Weder W, Inci I. Carinal resection and sleeve pneumonectomy. J Thorac Dis 2016; 8 (Suppl. 11) S882-S888 DOI: 10.21037/jtd.2016.08.47. (PMID: 27942410)
- 6 Honings J, van Dijck JA, Verhagen AF. et al. Incidence and treatment of tracheal cancer: a nationwide study in the Netherlands. Ann Surg Oncol 2007; 14: 968-976 DOI: 10.1245/s10434-006-9229-z. (PMID: 17139460)
- 7 Urdaneta AI, Yu JB, Wilson LD. Population based cancer registry analysis of primary tracheal carcinoma. Am J Clin Oncol 2011; 34: 32-37 DOI: 10.1097/COC.0b013e3181cae8ab. (PMID: 20087156)
- 8 Madariaga MLL, Gaissert HA. Overview of malignant tracheal tumors. Ann Cardiothorac Surg 2018; 7: 244-254 DOI: 10.21037/acs.2018.03.04. (PMID: 29707502)
- 9 Mitchell JD, Mathisen DJ, Wright CD. 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: 465-471 DOI: 10.1067/mtc.2001.112832. (PMID: 11241081)
- 10 Rea F, Marulli G, Schiavon M. et al. Tracheal sleeve pneumonectomy for non small cell lung cancer (NSCLC): short and long-term results in a single institution. Lung Cancer 2008; 61: 202-208 DOI: 10.1016/j.lungcan.2007.12.015. (PMID: 18280612)
- 11 Regnard JF, Perrotin C, Giovannetti R. et al. Resection for tumors with carinal involvement: technical aspects, results, and prognostic factors. Ann Thorac Surg 2005; 80: 1841-1846 DOI: 10.1016/j.athoracsur.2005.04.032.
- 12 Eichhorn F, Storz K, Hoffmann H. et al. Sleeve pneumonectomy for central non-small cell lung cancer: indications, complications, and survival. Ann Thorac Surg 2013; 96: 253-258 DOI: 10.1016/j.athoracsur.2013.03.065. (PMID: 23673074)
- 13 Dartevelle PG, Macchiarini P, Chapelier AR. 1986: Tracheal sleeve pneumonectomy for bronchogenic carcinoma: report of 55 cases. Updated in 1995. Ann Thorac Surg 1995; 60: 1854-1855 DOI: 10.1016/0003-4975(95)00506-4. (PMID: 8787505)
- 14 Schieren M, Wappler F, Defosse J. Anesthesia for tracheal and carinal resection and reconstruction. Curr Opin Anaesthesiol 2022; 35: 75-81 DOI: 10.1097/ACO.0000000000001082. (PMID: 34873075)
- 15 Chen L, Wang Z, Zhao H. et al. Carinal resection and reconstruction with complete pulmonary parenchyma preservation: a single-institution analysis of 36 cases. Transl Lung Cancer Res 2021; 10: 4526-4537 DOI: 10.21037/tlcr-21-937.
- 16 Pulle MV, Puri HV, Asaf BB. et al. Carinal Resection and Reconstruction for Tracheo-bronchial Neoplasms-Surgical Outcomes of 20 Consecutively Operated Cases. Indian J Surg Oncol 2021; 12: 12-21 DOI: 10.1007/s13193-020-01198-0. (PMID: 33814827)
- 17 Mitchell JD, Mathisen DJ, Wright CD. et al. Clinical experience with carinal resection. J Thorac Cardiovasc Surg 1999; 117: 39-52 DOI: 10.1016/s0022-5223(99)70468-x.
- 18 Sandberg W. Anesthesia and airway management for tracheal resection and reconstruction. Int Anesthesiol Clin 2000; 38: 55-75 DOI: 10.1097/00004311-200001000-00005. (PMID: 10723669)
- 19 Magnusson L, Lang FJ, Monnier P. et al. Anaesthesia for tracheal resection: report of 17 cases. Can J Anaesth 1997; 44: 1282-1285 DOI: 10.1007/BF03012777. (PMID: 9429047)
- 20 Qiu Y, Yu F, Yao F. et al. The efficacy of high-frequency jet ventilation on intraoperative oxygen saturation compared to cross-field ventilation in patients undergoing carinal resection and reconstruction. J Thorac Dis 2022; 14: 3197-3204 DOI: 10.21037/jtd-22-355. (PMID: 36245598)
- 21 Casiraghi M, Mariolo AV, Galetta D. et al. Carinal resection: technical tips. J Vis Surg 2018; 4: 122 DOI: 10.21037/jovs.2018.05.23.
- 22 Ning Y, Chen Z, Zhang W. et al. Uniportal three-arm robotic-assisted thoracic surgery right upper lobe and carinal sleeve resection. Ann Cardiothorac Surg 2023; 12: 70-72 DOI: 10.21037/acs-2022-urats-17. (PMID: 36793989)
- 23 Pan H, Zou N, Huang J. et al. Short- and medium-term outcomes of video-assisted thoracoscopic surgery versus thoracotomy for carinal lung resection combined with carina reconstruction in locally advanced non-small cell lung cancer patients. Thorac Cancer 2023; 14: 1742-1752 DOI: 10.1111/1759-7714.14919.
- 24 Li J, Wang W, Jiang L. et al. Video-Assisted Thoracic Surgery Resection and Reconstruction of Carina and Trachea for Malignant or Benign Disease in 12 Patients: Three Centers’ Experience in China. Ann Thorac Surg 2016; 102: 295-303 DOI: 10.1016/j.athoracsur.2016.01.080. (PMID: 27112644)
- 25 Lei J, Su K, Li XF. et al. ECMO-assisted carinal resection and reconstruction after left pneumonectomy. Journal of cardiothoracic surgery 2010; 5: 89 DOI: 10.1186/1749-8090-5-89. (PMID: 20961431)
- 26 Voltolini L, Salvicchi A, Cianchi G. et al. Extracorporeal membrane oxygenation support in carinal resection for recurrent chondrosarcoma after previous distal tracheal resection. Interact Cardiovasc Thorac Surg 2022; 35: ivac148 DOI: 10.1093/icvts/ivac148. (PMID: 35652753)
- 27 Pu H, Lei Y, Yuan D. et al. Tracheal Reconstruction Surgery Supported by Extracorporeal Membrane Oxygenation for Patients with Traumatic Post-Tracheotomy Tracheal Stenosis. Ann Thorac Cardiovasc Surg 2020; 26: 327-331 DOI: 10.5761/atcs.oa.20-00005.
- 28 Gonzalez-Rivas D, Essa RA, Motas N. et al. Uniportal robotic-assisted thoracic surgery lung-sparing carinal sleeve resection and reconstruction. Ann Cardiothorac Surg 2023; 12: 130-132 DOI: 10.21037/acs-2022-urats-86. (PMID: 37035649)
- 29 Suk P, Šrámek V, Čundrle jr I. Extracorporeal Membrane Oxygenation Use in Thoracic Surgery. Membranes (Basel) 2021; 11: 416 DOI: 10.3390/membranes11060416. (PMID: 34072713)
- 30 Jiang L, Liu J, Gonzalez-Rivas D. et al. Thoracoscopic surgery for tracheal and carinal resection and reconstruction under spontaneous ventilation. J Thorac Cardiovasc Surg 2018; 155: 2746-2754 DOI: 10.1016/j.jtcvs.2017.12.153. (PMID: 29548583)
- 31 Liang H, Gonzalez-Rivas D, Zhou Y. et al. Nonintubated Anesthesia for Tracheal/Carinal Resection and Reconstruction. Thorac Surg Clin 2020; 30: 83-90 DOI: 10.1016/j.thorsurg.2019.08.007. (PMID: 31761287)
- 32 Costantino CL, Geller AD, Wright CD. et al. Carinal surgery: A single-institution experience spanning 2 decades. J Thorac Cardiovasc Surg 2019; 157: 2073-2083.e1 DOI: 10.1016/j.jtcvs.2018.11.130.
- 33 Yamamoto K, Miyamoto Y, Ohsumi A. et al. Surgical results of carinal reconstruction: an alterative technique for tumors involving the tracheal carina. Ann Thorac Surg 2007; 84: 216-220 DOI: 10.1016/j.athoracsur.2007.01.034. (PMID: 17588416)
- 34 Wright CD, Grillo HC, Wain JC. et al. Anastomotic complications after tracheal resection: prognostic factors and management. J Thorac Cardiovasc Surg 2004; 128: 731-739 DOI: 10.1016/j.jtcvs.2004.07.005. (PMID: 15514601)
- 35 Valesky A, Lehnhardt FJ, Schildberg FW. [Wound healing of tracheal anastomoses]. Chirurg 1981; 52: 648-653 (PMID: 7028414)
- 36 Valesky A, Hohlbach G, Schildberg FW. [Validity of different methods for reducing tension of anastomoses following circular resection of the trachea]. Langenbecks Arch Chir 1983; 360: 59-69 DOI: 10.1007/BF01255583. (PMID: 6877004)
- 37 Rosen FS, Pou AM, Buford WL. Tracheal resection with primary anastomosis in cadavers: the effects of releasing maneuvers and length of tracheal resection on tension. Ann Otol Rhinol Laryngol 2003; 112: 869-876 DOI: 10.1177/000348940311201008. (PMID: 14587978)
- 38 Herrmann D, Oggiano M, Gencheva-Bozhkova P. et al. Carinal sleeve resection: last exit for bronchial insufficiency-a 17-year, single-centre experience. Interact Cardiovasc Thorac Surg 2021; 32: 921-927 DOI: 10.1093/icvts/ivab031. (PMID: 33772313)
- 39 Kutlu CA, Goldstraw P. Tracheobronchial sleeve resection with the use of a continuous anastomosis: results of one hundred consecutive cases. J Thorac Cardiovasc Surg 1999; 117: 1112-1117 DOI: 10.1016/s0022-5223(99)70247-3.
- 40 Hamad AM, Marulli G, Rizzardi G. et al. Multiple-running suture technique for bronchial anastomosis in difficult sleeve resection. Ann Thorac Surg 2009; 87: 975-976 DOI: 10.1016/j.athoracsur.2008.07.029. (PMID: 19231447)
- 41 Chakaramakkil MJ, Jim LY, Soon JL. et al. Continuous absorbable suture technique for tracheobronchial sleeve resections. Asian Cardiovasc Thorac Ann 2011; 19: 44-47 DOI: 10.1177/0218492310396085. (PMID: 21357317)
- 42 Bayram AS, Erol MM, Salci H. et al. Basic interrupted versus continuous suturing techniques in bronchial anastomosis following sleeve lobectomy in dogs. Eur J Cardiothorac Surg 2007; 32: 852-854 DOI: 10.1016/j.ejcts.2007.09.005. (PMID: 17913509)
- 43 Tapias LF, Ott HC, Mathisen DJ. Complications Following Carinal Resections and Sleeve Resections. Thorac Surg Clin 2015; 25: 435-447 DOI: 10.1016/j.thorsurg.2015.07.003. (PMID: 26515944)
- 44 Yamamoto R, Tada H, Kishi A. et al. Effects of preoperative chemotherapy and radiation therapy on human bronchial blood flow. J Thorac Cardiovasc Surg 2000; 119: 939-945 DOI: 10.1016/S0022-5223(00)70089-4. (PMID: 10788815)
- 45 Turrentine MW, Kesler KA, Wright CD. et al. Effect of omental, intercostal, and internal mammary artery pedicle wraps on bronchial healing. Ann Thorac Surg 1990; 49: 574-578 DOI: 10.1016/0003-4975(90)90303-n. (PMID: 2322052)
- 46 Ishihara T, Nemoto E, Kikuchi K. et al. Does pleural bronchial wrapping improve wound healing in right sleeve lobectomy?. J Thorac Cardiovasc Surg 1985; 89: 665-672
- 47 Ludwig C. Prophylaxis and management of postoperative complications after tracheobronchial surgery. J Thorac Dis 2020; 12: 6179-6184 DOI: 10.21037/jtd.2020.03.63. (PMID: 33209456)
- 48 Van Schil PE. Wrapping of bronchial anastomoses: something of the past?. Eur J Cardiothorac Surg 2012; 42: 81-82 DOI: 10.1093/ejcts/ezr275. (PMID: 22290916)
- 49 Muehrcke DD, Grillo HC, Mathisen DJ. Reconstructive airway operation after irradiation. Ann Thorac Surg 1995; 59: 14-18 DOI: 10.1016/0003-4975(94)00751-R. (PMID: 7818313)
- 50 Koryllos A, Lopez-Pastorini A, Zalepugas D. et al. Bronchus Anastomosis Healing Depending on Type of Neoadjuvant Therapy. Ann Thorac Surg 2020; 109: 879-886 DOI: 10.1016/j.athoracsur.2019.10.049. (PMID: 31843636)
- 51 Lopez-Pastorini A, Eckermann C, Koryllos A. et al. Clinical and bronchoscopic aspects of bronchial healing after sleeve resection for lung cancer: a multivariate analysis on 541 cases. J Thorac Dis 2022; 14: 927-938 DOI: 10.21037/jtd-21-1627. (PMID: 35572887)
- 52 Ludwig C, Riedel R, Schnell J. et al. Inhalation with Tobramycin to improve healing of tracheobronchial reconstruction. Eur J Cardiothorac Surg 2009; 35: 797-800 DOI: 10.1016/j.ejcts.2008.12.048.
- 53 Ludwig C, Stoelben E. A new classification of bronchial anastomosis after sleeve lobectomy. J Thorac Cardiovasc Surg 2012; 144: 808-812 DOI: 10.1016/j.jtcvs.2012.06.036. (PMID: 22841439)