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J Thorac Cardiovasc Surg 2001;121:0234-0240
© 2001 The American Association for Thoracic Surgery

General Thoracic Surgery

Complications of tracheal sleeve pneumonectomy: Personal experience and overview of the literature

Giancarlo Roviaro, MD, FACS, Federico Varoli, MD, Alberto Romanelli, MD, Contardo Vergani, MD, Marco Maciocco, MD

From the Department of General Surgery, San Giuseppe Hospital FbF, Milan, Italy.

Received for publication April 10, 2000. Revisions requested May 18, 2000; revisions received Sept 18, 2000. Accepted for publication Sept 21, 2000. Address for reprints: Giancarlo Roviaro, MD, Head, Department of General Surgery, San Giuseppe Hospital FbF, Via San Vittore, 12, 20122 Milan, Italy.

Objectives: Tracheal sleeve pneumonectomy, although technically demanding, is considered the choice for tracheobronchial angle cancers. Complications in our 49 tracheal sleeve pneumonectomies are reviewed. Results, complications, and technical aspects are critically discussed. Although series in the literature differ in selection of patients and surgical techniques and extend over long periods, we attempt to compare our experience with results from the literature.
Methods: From 1983 to September 1999, 60 patients eligible for tracheal sleeve pneumonectomy after conventional staging underwent operation. A Sybilla Fome-Cuf ventilation tube (Bivona, Inc, Gary, Ind) was used starting in 1987 to facilitate anastomosis. Since 1993, all patients have undergone video-assisted thoracoscopy immediately before the operation.
Results: There were 11 (18.3%) exploratory thoracotomies, 48 right tracheal sleeve pneumonectomies, and 1 left tracheal sleeve pneumonectomy. Among the tracheal sleeve pneumonectomies, we recorded 4 (8.2%) perioperative deaths (myocardial infarction, n = 1; heart failure, n = 1; pulmonary edema, n = 1; gastric ulcer hemorrhage, n = 1; and anastomotic fistula in a patient who received high-dose radiation before the operation, n = 1). We observed 5 (10.2%) complications (lung edema, n = 1; transitory recurrent nerve palsy, n = 2; empyema without fistula cured conservatively, n = 1; and pneumonia, n = 1). Anastomotic stenosis did not occur. Twenty-six (53%) patients are alive 14 to 87 months postoperatively, 12 (24.5%) of these more than 5 years postoperatively. Five (10.2%) died of mediastinal recurrence at 6 and 54 months. Two others (4.1%) died in road accidents.
Conclusions: Tracheal sleeve pneumonectomy is a demanding operation with a high risk of complications. Analysis of literature and personal experience shows that complications can be greatly reduced through accurate selection of patients, precise technique, and optimal postoperative care. Long-term survival equals that obtained after standard pneumonectomy.






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