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Surgical techniques and results of the pulmonary artery reconstruction for patients with central non-small cell lung cancer.

Ma Q, Liu D, Guo Y, Shi B, Tian Y, Song Z, Zhang Z, Ge B, Wang X, D'Amico TA - J Cardiothorac Surg (2013)

Bottom Line: In 41 patients, bronchial sleeve resection was associated; in 7 cases, superior vena cava reconstruction was also required.Our results support this technique as an effective alternative to selected patients with infiltration of the pulmonary artery, such as stage I and II and those who proved down-staged from stage III.Accurate preoperative evaluation, precise and suitable surgical techniques are crucial to achieve good results.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General Thoracic Surgery, China-Japan Friendship Hospital, 2 Yinghua East Road, Chaoyang, Beijing 100029, China. deruoliu@yahoo.com.

ABSTRACT

Background: It is difficult to achieve a margin-negative resection (R0) for non-small cell lung cancer (NSCLC) patients with infiltration of the pulmonary artery. We report our experience of the pulmonary artery reconstruction with regard to long-term survival.

Methods: Clinical records of 118 patients with NSCLC who underwent partial or circumferential pulmonary artery resection during a 21-year period were reviewed retrospectively. Techniques and survival outcomes were analyzed.

Results: We performed 22 pulmonary artery sleeve resections, 51 reconstructions by autologous pericardial patch, 36 tangential resections, 3 left main pulmonary artery (PA) angioplasties during pneumonectomy without cardiopulmonary bypass, and 6 by only preserving the apical and anterior (1(st)) branch of pulmonary arterial trunk. In 41 patients, bronchial sleeve resection was associated; in 7 cases, superior vena cava reconstruction was also required. Thirty-one patients received induction therapy. Thirteen patients had stage IB disease, 41 stage II, 53 IIIA, and 11 IIIB. Ninety-three patients had squamous cell carcinoma, 22 adenocarcinoma, 2 mixed and 1 large cell carcinoma. Negative vascular margins were achieved in all. 5 positive bronchial margins were due to limited lung function. The analysis of 118 cases yielded follow-up data in 94 cases. The mean follow-up was 70 months (range 1-156 months). There was no in hospital death, and the overall 5-year survival was 50.2%. Five-year survivals for stages I and II versus III were 63.9% versus 37.0% (p = 0.0059). Multivariate analysis yielded non-squamous cell carcinoma, stage III and patch pulmonary arterioplasty as negative prognosis factors. PA reconstruction associated with bronchial sleeve resection was the positive prognostic factor.

Conclusions: Pulmonary artery resection and reconstruction is feasible and safe, with favorable long-term survival. Our results support this technique as an effective alternative to selected patients with infiltration of the pulmonary artery, such as stage I and II and those who proved down-staged from stage III. Accurate preoperative evaluation, precise and suitable surgical techniques are crucial to achieve good results. Only preserving the anterior and apical pulmonary arteries and reconstruction of the main pulmonary artery by using the artery conduit technique without cardiopulmonary bypass in association with left pneumonectomy can be performed successfully. Postoperative anticoagulation is unnecessary.

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Only preserved the truncus anterior (both anterior and apical pulmonary artery branches) for bilobectomy (Right middle & lower lobectomy).
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Figure 4: Only preserved the truncus anterior (both anterior and apical pulmonary artery branches) for bilobectomy (Right middle & lower lobectomy).

Mentions: In a few cases, the pulmonary ateries were intensively infiltrated below the level of the 1st branch (anterior and apical pulmonary arteries) by tumor or lymph nodes. We only kept the 1st branch to perfuse the entire right or left upper lobe, and then performed bilobectomy (right middle & lower lobes) or left lower lobectomy, as shown in Figure 4 and Figure 5. If the space for surgery was limited and the 1st branch originated more proximal to heart, we suggest opening pericardial sac to expose the root of main pulmonary artery. Next, an occlusive clamp at the root level of main PA can be placed to facilitate safer control of the inflow. There were 6 patients who received this surgery, and no evidence of insufficiency of blood infusion or hypoxemia was found. Postoperative outcomes were acceptable.


Surgical techniques and results of the pulmonary artery reconstruction for patients with central non-small cell lung cancer.

Ma Q, Liu D, Guo Y, Shi B, Tian Y, Song Z, Zhang Z, Ge B, Wang X, D'Amico TA - J Cardiothorac Surg (2013)

Only preserved the truncus anterior (both anterior and apical pulmonary artery branches) for bilobectomy (Right middle & lower lobectomy).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4222057&req=5

Figure 4: Only preserved the truncus anterior (both anterior and apical pulmonary artery branches) for bilobectomy (Right middle & lower lobectomy).
Mentions: In a few cases, the pulmonary ateries were intensively infiltrated below the level of the 1st branch (anterior and apical pulmonary arteries) by tumor or lymph nodes. We only kept the 1st branch to perfuse the entire right or left upper lobe, and then performed bilobectomy (right middle & lower lobes) or left lower lobectomy, as shown in Figure 4 and Figure 5. If the space for surgery was limited and the 1st branch originated more proximal to heart, we suggest opening pericardial sac to expose the root of main pulmonary artery. Next, an occlusive clamp at the root level of main PA can be placed to facilitate safer control of the inflow. There were 6 patients who received this surgery, and no evidence of insufficiency of blood infusion or hypoxemia was found. Postoperative outcomes were acceptable.

Bottom Line: In 41 patients, bronchial sleeve resection was associated; in 7 cases, superior vena cava reconstruction was also required.Our results support this technique as an effective alternative to selected patients with infiltration of the pulmonary artery, such as stage I and II and those who proved down-staged from stage III.Accurate preoperative evaluation, precise and suitable surgical techniques are crucial to achieve good results.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General Thoracic Surgery, China-Japan Friendship Hospital, 2 Yinghua East Road, Chaoyang, Beijing 100029, China. deruoliu@yahoo.com.

ABSTRACT

Background: It is difficult to achieve a margin-negative resection (R0) for non-small cell lung cancer (NSCLC) patients with infiltration of the pulmonary artery. We report our experience of the pulmonary artery reconstruction with regard to long-term survival.

Methods: Clinical records of 118 patients with NSCLC who underwent partial or circumferential pulmonary artery resection during a 21-year period were reviewed retrospectively. Techniques and survival outcomes were analyzed.

Results: We performed 22 pulmonary artery sleeve resections, 51 reconstructions by autologous pericardial patch, 36 tangential resections, 3 left main pulmonary artery (PA) angioplasties during pneumonectomy without cardiopulmonary bypass, and 6 by only preserving the apical and anterior (1(st)) branch of pulmonary arterial trunk. In 41 patients, bronchial sleeve resection was associated; in 7 cases, superior vena cava reconstruction was also required. Thirty-one patients received induction therapy. Thirteen patients had stage IB disease, 41 stage II, 53 IIIA, and 11 IIIB. Ninety-three patients had squamous cell carcinoma, 22 adenocarcinoma, 2 mixed and 1 large cell carcinoma. Negative vascular margins were achieved in all. 5 positive bronchial margins were due to limited lung function. The analysis of 118 cases yielded follow-up data in 94 cases. The mean follow-up was 70 months (range 1-156 months). There was no in hospital death, and the overall 5-year survival was 50.2%. Five-year survivals for stages I and II versus III were 63.9% versus 37.0% (p = 0.0059). Multivariate analysis yielded non-squamous cell carcinoma, stage III and patch pulmonary arterioplasty as negative prognosis factors. PA reconstruction associated with bronchial sleeve resection was the positive prognostic factor.

Conclusions: Pulmonary artery resection and reconstruction is feasible and safe, with favorable long-term survival. Our results support this technique as an effective alternative to selected patients with infiltration of the pulmonary artery, such as stage I and II and those who proved down-staged from stage III. Accurate preoperative evaluation, precise and suitable surgical techniques are crucial to achieve good results. Only preserving the anterior and apical pulmonary arteries and reconstruction of the main pulmonary artery by using the artery conduit technique without cardiopulmonary bypass in association with left pneumonectomy can be performed successfully. Postoperative anticoagulation is unnecessary.

Show MeSH
Related in: MedlinePlus