Tracheal sleeve pneumonectomy: indications and surgical operative techniques

Tracheal sleeve pneumonectomy is a challenging surgical procedure for resection of cancers involving lung, lower trachea, carina and tracheobronchial angle. The most common indications are non-small cell lung cancers, bronchogenic carcinoma, carcinoid tumor, adenoid cystic carcinoma or inflammatory strictures. Other common indication is a positive resection margin after a standard pneumonectomy. This type of surgery is currently still infrequent, because of the complexity and the high risk of complications. The recent improvement of surgical techniques, different ventilation modalities and postoperative management has reduced dramatically the mortality and morbidity, especially in high volume centers. The careful selection of the patient and the correct preoperative staging is the central point for a successful operation. In this chapter we summarize “at a glance” the main topics of this kind of surgery, focusing on tips and tricks of the right patients selection, surgical techniques, postoperative management.