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Lobectomy with tangential pulmonary artery resection without regard to pulmonary function
J B Shrager1, E S Lambright, C M McGrath
1Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, USA. jshrag@mail.med.upenn.edu
The Annals of Thoracic Surgery
|August 2, 2000
Summary
Pulmonary artery resection and reconstruction (PAR) using tangential excision is a viable alternative to pneumonectomy for non-small cell lung cancer invading the pulmonary artery. This approach offers acceptable survival rates and low recurrence, making it a sound option when anatomically feasible.
Area of Science:
- Thoracic Surgery
- Surgical Oncology
- Pulmonary Medicine
Background:
- Non-small cell lung cancer invading the pulmonary artery traditionally requires pneumonectomy.
- Pulmonary artery resection and reconstruction (PAR) is gaining acceptance.
- Previous unfavorable outcomes with simple tangential excision and primary repair necessitated further investigation.
Purpose of the Study:
- To evaluate the safety and efficacy of performing PAR preferentially via tangential excision and primary repair for non-small cell lung cancer invading the pulmonary artery.
- To determine if this approach is a sound alternative to pneumonectomy.
Main Methods:
- Retrospective review of 33 patients who underwent PAR between 1992 and 1999.
- Procedures included tangential excision with primary closure, pericardial patch closure, or sleeve resections.
- Analysis of patient demographics, tumor staging, operative details, complications, survival, and recurrence.
Main Results:
- No operative deaths and a 6.1% rate of early major complications unrelated to PAR.
- Four-year Kaplan-Meier survival rates of 48.3% for stages I/II and 45% for stage III.
- A low ipsilateral, central, intrathoracic recurrence rate of 9.1%.
Conclusions:
- Lobectomy with PAR by tangential excision is an acceptable alternative to pneumonectomy when anatomically possible.
- The outcomes are comparable to standard resections, despite small study numbers.
- This technique offers a viable option for lung cancer patients with pulmonary artery invasion.
