Key Points

• Careful patient selection and detailed evaluation of the lesion are key to good surgical results in carinal resection.
• The safe limit of resection between the lower trachea and the contralateral main bronchus is about 4 cm. This is particularly important if a right carinal pneumonectomy is performed and the left main stem bronchus is to be reanastomosed end-to-end to the distal trachea.
• Close cooperation between the anesthetist and the surgeon is important because of the need for adequate surgical exposure and simultaneous control of the airway.

Refinement in techniques of tracheal surgery and bronchial sleeve lobectomy has made carinal resection and reconstruction possible. However, the potential for complications remains high, and only a few centers have accumulated sufficient expertise to safely perform the operation.

Results from recent series demonstrate that carinal resection is safe in experienced centers, with an operative mortality rate of less than 10%, and can be associated with good to excellent long-term survival in selected patients. The current results are considerably better than those from earlier reported series and most likely reflect the improvements in surgical and anesthetic techniques. Careful patient selection and detailed evaluation are also important requirements for good surgical results.