OBJECTIVETo summarise and analyse the experience and methods of managing the perioperative respiratory problems in patients with tumor of trachea or carina surgically treated during the last decade, and the ways of preventing severe postoperative respiratory complications in the future.

METHODSThirty-eight patients with tumor of trachea or carina surgically treated from 1991 to 2000 by different modes of tracheobronchial plastic surgery were retrospectively studied to summarise and analyse the changes in preoperative pulmonary function, postoperative complications and the management of perioperative respiratory problems.

RESULTSOut of 38 patients, 29 (76.3%) gave abnormal results to preoperative pulmonary function tests. 55.3% (21/38) of the whole series developed 45 postoperative complications with respiratory complications as the major one (80.0%). Seventeen patients who had undergone carinal pneumonectomy or carinal resection plus reconstruction gave far more complications (28 complications) than the remaining 21 patients treated by other modes of surgery (17 complications). Four patients died of postoperative complications with a mortality rate of 10.5%.

CONCLUSIONPatients treated with carinal pneumonectomy or carinal resection plus reconstruction give much more complications than patients treated by any other modes of large airway surgery. Fiberoptic bronchoscopic (FOB) guided intubation, precise surgical treatment, postoperative mechanical ventilation support, use of effective antibiotics and sufficient nutritional support are important for a successful management of these patients.