Reverse Barclay carinal resection for tracheo-carinal primary tumor (Eschapasse Technique)

Purpose: To present the reverse Barclay carinal resection for primary tracheocarinal tumors (the Eschapasse technique). Methods: A 57-year-old woman, with dysphonia, stridor and dry cough underwent a CT scan and PET-CT scan that revealed a partial obstruction of the distal part of the trachea and carina. The bronchoscopic evaluation confirmed the lesion arising from the left anterolateral tracheal wall with the involvement of the carina and the left main bronchus. The biopsy diagnosed an adenoid cystic carcinoma. A transesophageal echography showed a cleavage plane with the aorta and esophagus. Results: Through a median sternotomy, the trachea, carina, and both main bronchi were isolated. The carina with the lower trachea and the left main bronchus were then resected. The reconstruction of the airway was achieved by an end-to-end anastomosis between trachea and left main bronchus and a sideto- end anastomosis between the trachea and right main bronchus (reverse Barclay\u2019s resection). Conclusion: Even though primary tracheal and carinal tumors are rare, thoracic surgeons must be familiar with the wide variety surgical techniques for the treatment of these complex lesions. The reverse Barclay\u2019s resection is a safe procedure in experienced hands, providing good technical and oncological results