Reconstruction of the pulmonary artery in patients with lung cancer (original) (raw)
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The Annals of thoracic surgery, 2015
Pulmonary artery (PA) reconstruction for lung cancer is technically feasible with low morbidity and mortality. We assessed our experience with partial or circumferential resection of the PA during lung resection. Between 1998 and 2013, we performed PA angioplasty in 150 patients with lung cancer. Partial PA resection was performed in 146 patients. PA reconstruction was performed by running suture in 113 patients and by using a pericardial patch in 33. A circumferential PA resection was performed in 4 patients, and reconstruction was made with polytetrafluoroethylene and by a custom-made bovine pericardial conduit. Bronchial sleeve resection was associated in 56 patients. Stage I disease was present in 32 patients, stage II in 43, stage IIIA in 51, and stage IIIB in 17. Seventy-five patients received induction chemotherapy, and 7 patients had a complete response. Thirty-day mortality was 3.3% (n = 5); two of these patients died of a massive hemoptysis. Pulmonary complications occurre...
The Annals of Thoracic Surgery, 2007
Background. We assessed our experience with partial or circumferential resection of the pulmonary artery during lobectomy. Methods. We retrospectively reviewed a prospective electronic database of patients who underwent pulmonary artery resection. The technique used was an R0 resection with end-to-end anastomosis only if needed, distal control of the pulmonary artery by clamping the vein (not the artery), and no postoperative anticoagulation. Results. Between October 1998 and June 6, 2006, 42 (3.2%) of 1328 patients who underwent lobectomy performed by one surgeon required resection of the pulmonary artery (38 partial, 4 circumferential) to achieve a margin-negative resection and avoid pneumonectomy. Of these, 41 had non-small cell lung cancer, and 23 (55%) had neoadjuvant chemoradiotherapy (median dose of 60 Gy). Right upper lobectomy was performed in 2 patients and a left upper lobectomy in 40. A negative bronchial and vascular margin was achieved in all. Morbidity occurred in 11 patients (atrial fibrillation in 6) and left recurrent laryngeal neurapraxia in 2. Aspiration resulted in one operative death. Follow-up (median, 48 months) showed no local recurrence on the pulmonary artery and normal blood flow through it. Five-year survival was 60%. Conclusions. Pulmonary artery resection and reconstruction to avoid pneumonectomy can be performed safely, even in a highly irradiated field. Clamping of the remaining pulmonary vein for distal control is safe and affords more room. Circumferential resection with endto-end anastomosis of the pulmonary artery is rarely required. Partial resection is safe, does not impede blood flow, and does not compromise local recurrence rates. Postoperative anticoagulation is not needed.
Reconstruction of the pulmonary artery for lung cancer: Long-term results
The Journal of Thoracic and Cardiovascular Surgery, 2009
Objective: Reconstruction of the pulmonary artery in association with lung resection is technically feasible with low morbidity and mortality. To assess long-term outcome, we report our 20-year experience. Methods: Between 1989 and 2008, we performed pulmonary artery reconstruction in 105 patients with nonsmall cell lung cancer (tangential resections not included). Twenty-seven patients received induction therapy. We performed 47 pulmonary artery sleeve resections, 55 reconstructions by pericardial patch (with 3 left pneumonectomies under cardiopulmonary bypass), and 3 by pericardial conduit. In 65 patients, a bronchial sleeve resection was associated; in 6 cases superior vena caval reconstruction was also required. Fifteen patients had stage IB disease, 37 stage II, 31 IIIA, and 22 IIIB. Sixty-one patients had epidermoid carcinoma, and 38 adenocarcinoma. Mean follow-up was 46 AE 40 months. Results: The procedure-related complications were 1 pulmonary artery thrombosis requiring completion pneumonectomy and 1 massive hemoptysis leading to death (operative mortality, 0.95%); 28 patients had other complications, with the most frequent prolonged air leakage. Overall 5-year survival was 44%. Five-and 10-year survivals for stages I and II versus stage III were, respectively, 60% versus 28% and 25% versus 12%. Fiveyear survivals were 52.6% for N0 and N1 nodal involvement versus 20% for N2; 10-year survivals were 28% versus 3%. Multivariate analysis yielded induction therapy, N2 status, adenocarcinoma, and isolated pulmonary artery reconstruction as negative prognostic factors. Conclusions: Pulmonary artery reconstruction is safe, with excellent long-term survival. Our results support this technique as an effective option for patients with lung cancer. MATERIALS AND METHODS From 1989 to 2008, we performed PA reconstruction on 105 consecutive patients. The study was approved by the Institutional Review Board of the University ''Sapienza'' of Rome. During this time, we performed a mean of
Lobectomy with angioplasty: which is the best technique for pulmonary artery reconstruction?
Journal of Thoracic Disease
Lobectomies with bronchial and/or vascular reconstruction are conservative procedures aimed at managing locally advanced lung cancer, avoiding a pneumonectomy. Considering morbidity, mortality and the functional consequences of a pneumonectomy, such procedures must be in the technical armamentarium of every thoracic surgeon. Vascular reconstruction of the pulmonary artery (PA) is seldom performed with or without the bronchial sleeve resection. Both functional and oncologic outcomes have been reported to be better than after a pneumonectomy. Different technical options are now available but some aspects and technical details are not standardized. Indications, possible complications, planning and even definitions need to be more solid to allow for definitive improvement in such procedures. This analysis is aimed at assessing the acquired technical data with special emphasis on the PA reconstruction with autologous tissues.
European Journal of Cardio-Thoracic Surgery, 1999
Extended sleeve pneumonectomy including removal of the superior vena cava, right atrium and parts of left atrium on cardiopulmonary bypass was successfully performed in a 40-year-old man. The tumour was histologically proven a T4 N1 stage with margins free from tumour. Adjuvant radiochemotherapy was administered postoperatively on an outpatient base. The patient did well for 7 months then he died from myocardial infarction due to metastatic infiltration of the right coronary artery. Other metastatic deposits were not found at autopsy. More data from extended pulmonary resections are required to demonstrate a benefit.
Lobectomy with tangential pulmonary artery resection without regard to pulmonary function
The Annals of Thoracic Surgery
Non-small cell carcinoma of the lung invading the pulmonary artery (PA) has traditionally been treated by pneumonectomy. Although PA resection and reconstruction (PAR) has begun to gain acceptance, previous series of PAR by the simplest technique of tangential excision and primary repair have been unfavorable. We have maintained a policy of performing PAR preferentially whenever anatomically feasible, and usually this has been possible by tangential excision and primary repair. This study sought to determine if this approach is sound. Retrospective clinical and pathologic review. Thirty-three PARs were performed from 1992 to 1999. The patients, followed 6 to 65 months (mean 25), were aged 36 to 80 years (mean 61), and their tumors were pathologic stage IB (n = 7), IIB (n = 13), IIIA (n = 9), and IIIB (n = 4). The mean preoperative forced expiratory volume in 1 second was 70% predicted. The procedures included 14 bronchial sleeve lobectomies with PAR and 19 simple lobectomies with PA...
Lung cancer (Amsterdam, Netherlands), 2006
Lung cancer may involve the pulmonary artery (PA) either by direct extension of the primary tumor or by invasion of the hilar lymph nodes. In these instances, a radical resection is usually a pneumonectomy despite distal functioning lung tissue. To spare the lung parenchyma, angioplastic procedures requiring removal of a portion of the arterial wall or a circumferential resection with arterial reconstruction have been used. Several techniques of pulmonary arterioplasty have been explored suggesting that the incidence of postoperative complications is acceptably low and long-term local control can be achieved. Over a period of 7 years, 84 angioplastic procedures (alone or associated with bronchoplasty) were performed at our institution. Partial PA resection was performed in 80 (95.2%) patients. Reconstruction was performed by running suture in 63 (75%) patients and using a pericardial patch in 17 (20.2%) cases (16 autologous and 1 heterologous). A complete PA resection and reconstruc...
Turkish Journal of Thoracic and Cardiovascular Surgery, 2015
Bu çalışmada günümüzde akciğer kanseri tedavisinde nadir olarak uygulanmakta olan pulmoner artere (PA) yama veya uç uca anastomoz yöntemleri ile rezeksiyon ve rekonstrüksiyon ameliyatlarının sonuçları bildirildi. Ça lış mapla nı:Ocak 2005-Ocak 2012 tarihleri arasında küçük hücreli dışı akciğer kanseri nedeniyle ameliyat edilen 712 hastanın 32'sine (26 erkek, 6 kadın; ort. yaş 62±8 yıl; dağılım 39-80 yıl) lobektomi ve PA majör rekonstrüksiyon cerrahisi (dördü otolog perikard yama, 10'u da politetrafloroetilen greft ile yama olmak üzere 14'üne parsiyel ve 18'ine sirkumferensiyal rezeksiyon) uygulandı. Bul gu lar: Medyan sağkalım 48±8 ay idi. Beş ve yedi yıllık sağkalım oranları sırasıyla %27 ve %9 idi. Ameliyata bağlı mortalite görülmedi. Morbidite oranı %41 (minör %31 ve majör %10) idi. Sağ taraflı ameliyat olan hastaların tümünde bronşiyal sleeve rezeksiyon da uygulanır iken, sol tarafta bu oran %59 idi (p= 0.03). 'Double sleeve' rezeksiyon oranı %47 idi. Pulmoner artere yama cerrahisi yapılan hastalarda medyan sağkalım oranı 60±36 ay, beş yıllık sağkalım oranı ise %37 iken, sirkumferensiyal rezeksiyon ve uç uca anastomoz yapılan hastalarda medyan sağkalım 43±13 ay, beş yıllık sağkalım oranı ise %22 bulundu (p= 0.38). Yama uygulaması ile sirkumferensiyel rezeksiyon ve uç uca anastomoz grubu arasında komplikasyon açısından istatistiksel olarak anlamlı fark yoktu (p= 0.808). 'Double sleeve' rezeksiyon uygulanan hastalarda beş yıllık sağkalım oranı %16 iken, diğerlerinde bu oran %48 idi (p= 0.282). Ayrıca sağkalımın tek değişkenli analizinde yaş (p= 0.185), taraf (p= 0.527), neoadjuvan tedavi (p=279), N durumu (p=0.878), adjuvant tedavi seçimi (p= 0.978) ve metastaz gelişimi (p= 0.471) açısından anlamlı bir fark görülmedi. Kadın cinsiyeti (p= 0.05), adjuvan tedavi (p= 0.001) ve ameliyat sonrası komplikasyon gelişimi (p= 0.038) uzun dönem sağkalım için pozitif öngördürücüler olarak bulundu. So nuç: Pnömonektomiden sakınmak için uygulanan PA rezeksiyonları ve rekonstrüksiyonları, düşük morbidite ve mortalite oranları ile uygulanabilen uygun ve etkili cerrahi işlemlerdir. Kadın cinsiyeti, ameliyat sonrası adjuvan onkolojik tedavi ve ameliyat sonrası süreçte komplikasyon gelişmemesinin uzun dönem sağkalımı etkileyebileceği görünmektedir.