Pulmonary artery reconstruction using cryopreserved allograft for lung cancer: a bi-centric comparative study

Pulmonary artery (PA) reconstruction during lung cancer surgery is a recognized parenchymal-sparing alternative to pneumonectomy. However, the use of cryopreserved allografts for PA reconstruction remains limited. This study aims to evaluate the surgical morbidity and mid-term performances of three different PA reconstruction techniques, including cryopreserved grafting, direct suture and end-to-end anastomosis, in lung cancer surgery.

We retrospectively analyzed all patients who underwent PA reconstruction following lung lobectomy with en-bloc vascular resection over a 20-year period in two tertiary lung surgery centers. The patients were assigned to three groups: patch closure of the PA (group 1, n=60), end-to-end anastomosis (group 2, n=24), and cryopreserved grafting (group 3, n=23).

The groups were comparable in terms of demographics, comorbidities, preoperative functional tests, and tumor-node-metastasis (TNM) stage. Overall morbidity was 44.9%, and overall mortality was 1.9%. There were no significant differences between the groups in postoperative mortality (P=0.10) or morbidity (P=0.30). There was no significant difference in perfusion of the remaining lobe (P=0.19) or the contralateral lung (P=0.12) between the groups. The patency rate was 96% in group 1, 95% in group 2, and 100% in group 3, although this difference was not statistically significant. Over a follow-up period of 32 months, the recurrence rate was 44.9% for the entire cohort. The risk factors for recurrence were pN+ status, squamous cell carcinoma histology and adjuvant therapy, while the type of PA reconstruction was not.

Cryopreserved allografts are a suitable material for PA reconstruction in lung cancer surgery providing mid-term performance without increasing operative risk when compared to other reconstructive techniques.