RT Book, Section A1 Ashiku, Simon K. A1 DeCamp, Malcolm M. A2 Sugarbaker, David J. A2 Bueno, Raphael A2 Colson, Yolonda L. A2 Jaklitsch, Michael T. A2 Krasna, Mark J. A2 Mentzer, Steven J. A2 Williams, Marcia A2 Adams, Ann SR Print(0) ID 1105841705 T1 Resection of the Carina T2 Adult Chest Surgery, 2e YR 2015 FD 2015 PB McGraw-Hill Education PP New York, NY SN 978-0-07-178189-3 LK accesssurgery.mhmedical.com/content.aspx?aid=1105841705 RD 2024/11/14 AB Airway neoplasms account for approximately 90% of carinal resections.1 The incidence of primary tracheal tumors is unclear, but is known to be rare. A recent population-based cancer registry analysis using the SEER database demonstrated an incidence of 2.6 tracheal tumor cases per 1,000,000 people per year.2 Carinal tumors, as a subcategory of tracheal tumors, are even less common. Most are malignant and can be divided into bronchogenic carcinoma and other airway neoplasms. Bronchogenic carcinomas are by definition malignant; the other airway neoplasms may exhibit a wide range of behavior. As demonstrated in Table 64-1, the most common malignant primary tracheal neoplasms are squamous cell carcinoma (SCC) and adenoid cystic carcinoma (ACC).3 SCC occurs primarily in smokers in their sixth and seventh decades and may present confined to the trachea or invading into adjacent mediastinal structures. ACC is an exophytic intratracheal lesion, which may involve the tracheal wall to variable extent (Fig. 64-1), and compress mediastinal structures without invading them initially. Lymph node metastases occur, but less commonly than in SCC. A characteristic feature of ACC is its proclivity for extending long distances submucosally and perineurally.