Background: Pneumonectomy and sleeve resection are routine operations for the treatment of central non-small cell lung cancer (NSCLC), but some patients suffered of central NSCLC, whose pulmonary function is too poor to tolerate pneumonectomy, or the tumor involves the bronchus and pulmonary artery extensively,it is hard to perform bronchovascular sleeve lobectomy. The aim of this study is to assess the feasibility of lung autotransplantation in the treatment of central NSCLC.
Methods: The clinical data of 3 cases with central NSCLC treated by lung autotransplantation was reviewed from December 2016 to December 2018. One patient underwent double sleeve resection of left upper lobe with end-to-end anastomosis of the bronchus. Because the resection of the pulmonary artery was too long to perfrom a tension-free anastomosis, the inferior pulmonary vein was cut off, then the left lower lobe was moved up for an anastomosis of the inferior pulmonary vein and the stump of the superior pulmonary vein. In the other 2 cases, left pneumonectomy was performed directly, and the upper left lobe was excised in vitro. The lower left lobe was reset to the chest after trimming and flushing and then the bronchus, pulmonary artery and pulmonary vein were anastomosed in turn.
Results: The average operation time was 333 min, the average time of vascular occlusion was 86 min, the average blood loss was 450 mL, and the average hospital stay was 18.7 d; Perioperative complications included a case of bronchial obstruction, which improved after sputum aspiration through bronchofibroscope. The average follow-up period was 20 mon; One case died of cancer, one case had recurrence of anastomotic stoma and brain metastasis, one case had 4R lymph node metastasis (stable condition after chemotherapy), and one case survived without recurrence.
Conclusions: For patients with central NSCLC with extensive tumor invasion, thus inability to tolerate sleeve resection or pneumonectomy, autologous lung transplantation can preserve lung function to the greatest extent with a complete tumor resection and improve postoperative quality of life.
【中文题目：自体肺移植治疗中央型非小细胞肺癌的疗效】 【中文摘要：背景与目的 全肺切除术和袖状切除术是治疗中央型非小细胞肺癌的常规术式，但存在肺功能差不能耐受全肺切除或因为肿瘤广泛侵犯支气管和肺动脉而不能进行袖状切除的情况。本研究旨在探讨自体肺移植治疗中央型非小细胞肺癌的可行性。方法 回顾性分析2016年12月-2018年12月3例行自体肺移植的中央型非小细胞肺癌患者的诊疗资料。1例双袖状切除左肺上叶，吻合支气管，因肺动脉切除过长，肺动脉吻合口张力大，遂切断下肺静脉，将下肺上移后再吻合肺动脉，最后将下肺静脉与上肺静脉残端吻合。2例行左全肺切除，体外切除左肺上叶，将修剪、灌洗后的左肺下叶重置胸腔，依次吻合支气管、肺动脉、肺静脉。结果 平均手术时间333 min，平均血流阻断65 min，平均出血量450 mL，平均住院日18.7 d；围手术期出现痰栓堵塞支气管1例，经支纤镜吸痰后好转；平均随访时间20个月，癌症死亡1例，术后吻合口复发及脑转移1例，4R淋巴结转移1例（经化疗后病情稳定），无复发生存1例。结论 对于肿瘤侵犯广泛，不能进行袖状切除或无法耐受全肺切除的中央型非小细胞肺癌患者，自体肺移植可在彻底切除肿瘤基础上最大限度保留肺功能，提高术后生存质量。】 【中文关键词：自体肺移植；肺肿瘤；袖状切除；全肺切除】.
Keywords: Lung autotransplantation; Lung neoplasms; Pneumonectomy; Sleeve lobectomy.