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

Journal of Cardiothoracic Surgery

Thomas A D’Amico¹  Xiaofei Wang³  Bingsheng Ge²  Zhenrong Zhang²  Zhiyi Song²  Yanchu Tian²  Bin Shi²  Yongqing Guo²  Deruo Liu²  Qianli Ma¹ 

[1] General Thoracic Surgery, Duke University Medical Center, Box 3496, Duke South, White Zone, Room 3589, 27710 Durham, NC, USA;Department of General Thoracic Surgery, China-Japan Friendship Hospital, 2 Yinghua East Road, Chaoyang, Beijing 100029, China;Department of Biostatistics & Bioinformatics, Duke University Medical Center, Duke Box 2721, 27710 Durham, NC, USA

关键词: Surgery;    Reconstruction;    Pulmonary artery;    Lung cancer;   

Others  :  814688
DOI  :  10.1186/1749-8090-8-219

 received in 2013-02-12, accepted in 2013-11-25,  发布年份 2013

【 摘 要 】

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.

【 授权许可】

   
2013 Ma et al.; licensee BioMed Central Ltd.

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