Pulmonary artery resections and reconstructions for lung cancer treatment: an anatomical-technical analysis and survival relationships

作者：Toker Alper; Demir Adalet^*; Kaba Erkan; Kapdagli Murat; Ziyade Sedat; Saracoglu Basak; Erus Suat; Ozkan Berker; Tanju Serhan

来源：Turkish Journal of Thoracic and Cardiovascular Surgery, 2015, 23(1): 66-74.

DOI：10.5606/tgkdc.dergisi.2015.9467

• Lobectomy
• lung cancer
• pulmonary artery
• sleeve resection

Background: This study aims to report the results of pulmonary arterial (PA) resections and reconstructions with either a patch or end-to-end anastomosis for lung cancer which are currently rarely used.
Methods: Between January 2005 and January 2012, 712 non-small cell lung cancer patients underwent surgery of which 32 (26 males, 6 females; mean age 62 8 years; range 39 to 80 years) had lobectomy and major reconstructive surgery for PA (14 partial, including four PA reconstructions with an autologous pericardial patch and 10 PA reconstructions with a polytetraflouroethylene graft and 18 circumferential).
Results: The median survival was 48 8 months. Five and seven-year survival rates were 27% and 9% respectively. No operative mortality was seen. Morbidity rates were 41% (minor 31% and major 10%). All patients with a right-sided resection had also a bronchial sleeve resections with a rate of 59% in the left lung (p=0.03). The rate of double sleeve resection was 47%. The median and five-year survival rates were 60 36 months and 37% in the arterial patch plasty operations respectively, whereas it was 43 13 months and 22% in circumferential resections and end-to-end anastomosis patients, respectively (p=0.38). There was no statistically significant difference in the complication rate between the circumferential resections with patch plasty operations and end-to-end anastomosis (p=0.808). Five-year survival rate was 16% in double sleeve resections and 48% in others (p=0.282). Univariate analysis of survival demonstrated no significant differences in terms of age (p=0.185), side (p=0.527), neoadjuvant treatment (p=279), N status (p=0.878), type of adjuvant treatment (p=0.978) and metastasis development (p=0.471). Female gender (p=0.05), adjuvant treatment (p=0.001) and development of postoperative complications (p=0.038) were identified as positive predictors for long-term survival.
Conclusion: Pulmonary arterial resections and reconstructions to prevent pneumonectomy are feasible and effective surgical procedures with acceptable morbidity and mortality rates. Female gender, postoperative adjuvant oncological treatment and non-complicated postoperative course appear to be potential influencing factors on long-term survival.

• 出版日期2015-1