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Background: Tracheal bifurcation resection remains the greatest challenge in airway reconstruction, especially with extensive lesions. Additionally, lung cancer and pulmonary tuberculosis comorbidity complicate the chemoradiotherapy treatment due to the TB reactivation. This case describes tracheal resection in a patient with both tuberculosis (TB) and lung cancer., Case Presentation: The patient was diagnosed with right lung tuberculosis and upper lobe cancer with trachea invasion complicated by hemoptysis. A right pneumonectomy with circular trachea bifurcation resection was performed. Radiotherapy and chemotherapy were not administered to avoid TB reactivation. At 5.5 years post-surgery, there was cancer recurrence that was treated with radiation therapy. At 10 years post-surgery, an invasive squamous-cell carcinoma of a three-segment bronchus on the left was revealed. Radiation therapy and a course of chemotherapy were carried out with almost complete tumor regression., Conclusions: TB presence should not serve as a basis for the refusal of cancer treatment. Combined treatment may be recommended when the main infection focus in the pulmonary parenchyma is removed during surgery.

The results of pneumonectomy with resection of tracheal bifurcation in 779 patients reported by 54 authors for the period of 44 years are reviewed. The analysis of all the data showed that this operation remains one of the most dangerous and rare surgical procedures. Lethality in total bifurcation resection averaged 24.3% and in partial resection--10.2%. Because of lack of experience there is no distinct indications for the operation in cancer patients. The authors have performed 111 pneumonectomies with bifurcation resection (39 with circulatory resection) with lethality of 2.7% and 5-year survival of 25%. This proves the ability of updated surgical technique to decrease surgical risk and extend indications for surgery of local cancer.

Two hundred-sixty four radical combined surgical operations (237 pneumonectomies and 27 lobectomies) were performed in 1981-1994. Two hundred-fifty four patients were operated on for cancer, 7-carcinoid and 3 patients for sarcoma. In 159 cases, tumors were identified as T3 and in 70 cases--as T4. Metastases into lymph nodes of the root and mediastinum--another 121 patients. Surgery alone was received by 90.5%. Mortality for the first 30 days was 1.9%. Twenty-six percent of patients with non-small cell carcinoma survived 5 years, small cell carcinoma-12.5% and carcinoid-100%. No significant difference in survival time was registered for T3 and T4 process.