Pulmonary Sparing for Resection of Adenoidcystic Carcinoma Involving the Tracheal Carina and the Right Main Bronchus: A Case Report

A 40 year old female underwent successful pulmonary sparing resection of an adenoidcystic carcinoma (ACC) of the tracheal carina involving the right main bronchus with a size of 3 cm. The operative technique: A right thoracotomy was performed. The trachea and main bronchi were dissected. The left main bronchus was transected about 1 cm from the carina. The airway management was intermittent conventional ventilation via the operative field. The right bronchus was transected at the upper lobe and the intermediated bronchus 1.0 cm from the tumor margin. Finally the trachea was transected 1 cm above the tumor margin. The proximal end of the trachea was anastomosed end to end to the distal left main bronchus. The intermediate bronchus was incised vertically and 2/3 of the circumferential distal end of the upper lobe bronchus was anastomosed end to side to the incisional line of the intermediate bronchus. Then the neo-bronchial orifice of the right bronchus was anastomosed end to side to the lateral wall of the trachea 1 cm above the previous tracheal anastomosis. The patient recovered well from the operation and was discharged within 2 weeks after the operation. Early postoperative fiberoptic bronchoscopy revealed adequated anastomotic bronchial lumens and minimal granulation tissue at the left bronchial anastomosis.