# Technical Options and Airway Management in Carinal Resections

## TL;DR

This paper reviews surgical techniques and airway management options for complex carinal resections in lung cancer surgery.

## Contribution

The paper provides a comprehensive overview of airway management techniques and surgical approaches in carinal resections.

## Key findings

- ECMO and crossfield ventilation are effective in facilitating airway reconstruction during carinal resections.
- Minimally invasive techniques are being increasingly considered for carinal resections.
- Collaboration between surgeons and anesthesiologists is crucial for successful outcomes.

## Abstract

Carinal resections are rare but extremely complex procedures and represent a challenging topic, with a range of indications and types of reconstruction available via different approaches, from open surgery to minimally invasive techniques. Airway maintenance is crucial, and the choice of technique may help or hinder the construction of the anastomosis. It also has an impact on postoperative morbidity. Alternative techniques such as ECMO are being utilized more often in general thoracic surgery and are considered a feasible alternative in complex airway surgery. We aim to provide a comprehensive overview of this topic, covering key issues in carinal resections in the wider context of non-small cell lung cancer surgery.

Background: Carinal resections remain a challenging and demanding surgical technique for both the patient and medical professionals. The most common indications are adenoid cystic carcinoma and bronchogenic carcinoma. There have been no randomized controlled trials because of the low incidence of pathologic processes suited to carinal resections and the difficulties associated with designing such studies. Methods: The known data are limited to a few single-institutional, retrospective studies over the last several decades. In this review article, we focus on the available data regarding surgical techniques and the types of ventilation that can help in the construction of the anastomosis—the most crucial part of the operation. Important issues regarding carinal resections are discussed in detail. Results: The available literature is reviewed in detail regarding indications, surgical techniques and approaches, types of ventilation, the rates of morbidity and mortality, and 5-year survival. The authors present their experience with two patients, where they utilized ECMO and crossfield ventilation. The role of minimally invasive surgery in carinal resections is also discussed. Conclusions: Carinal resections are complex surgical procedures, but acceptable mortality and morbidity rates can be achieved in carefully selected patients. Excellent cooperation between the surgeon and anesthesiologist is essential in the construction of the anastomosis. Various types of airway management, especially ECMO, help to reduce complication rates and facilitate secure airway reconstruction.