Sleeve Resection and Prosthetic Reconstruction of the Pulmonary Artery for Lung Cancer

Ann Thorac Surg. 1999 Sep;68(3):995-1001; discussion 1001-2. doi: 10.1016/s0003-4975(99)00738-9.

Abstract

Background: Lobectomy associated with reconstruction of the pulmonary artery (PA) is a technically feasible alternative to pneumonectomy in patients with lung cancer. However, concern about postoperative complications and long-term survival limited its acceptance so far.

Methods: Between 1989 and 1996, we performed a PA reconstruction in 52 patients (41 men, 11 women; age range 35 to 75 years, mean 60 years) with lung cancer. Eleven patients had induction chemotherapy. We performed 15 PA sleeve resections, 34 PA reconstructions by a pericardial patch, and three PA reconstructions by a pericardial conduit, associated with a bronchial sleeve lobectomy or bilobectomy (33), or with standard lobectomy (19). Immediate and long-term postoperative evaluation included spirometry, echocardiography, perfusion lung scans, computed tomography, and PA angiography. The follow-up ranged between 27 and 96 months and is complete for all patients.

Results: We had one specific postoperative complication (PA thrombosis) and no mortality. Perfusion scans and PA angiography were normal in all but the 1 patient having thrombosis. Mean forced expiratory volume (FEV) in 1 s and forced vital capacity (FVC) were, respectively, 72% and 80% preoperatively, 65% and 76% 1 month after surgery, and then they plateaued at 70% and 78% after 6 months. Echocardiography showed patterns in the normal range and normal estimates of PA pressures in all but 2 patients. Five-year survival was 38.3% for the entire group, 18.6% for stages IIIA and B, and 64.4% for stages I and II.

Conclusions: Morbidity, mortality, and functional data do not differ from what is currently reported for standard lobectomy. Long-term survival is in line with that reported for standard resection. These data support PA reconstruction as a viable option in the treatment of lung cancer.

MeSH terms

  • Adult
  • Aged
  • Anastomosis, Surgical
  • Bronchi / surgery
  • Carcinoma, Non-Small-Cell Lung / mortality
  • Carcinoma, Non-Small-Cell Lung / physiopathology
  • Carcinoma, Non-Small-Cell Lung / surgery*
  • Female
  • Forced Expiratory Volume
  • Humans
  • Lung Neoplasms / mortality
  • Lung Neoplasms / physiopathology
  • Lung Neoplasms / surgery*
  • Male
  • Middle Aged
  • Pneumonectomy
  • Postoperative Complications
  • Pulmonary Artery / diagnostic imaging
  • Pulmonary Artery / surgery*
  • Radiography
  • Reconstructive Surgical Procedures
  • Survival Rate
  • Vital Capacity