Robert J Cerfolio1, Ayesha S Bryant. 1. Division of Cardio-Thoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA. robert.cerfolio@ccc.uab.edu
Abstract
BACKGROUND: We assessed our experience with partial or circumferential resection of the pulmonary artery during lobectomy. METHODS: We retrospectively reviewed a prospective electronic database of patients who underwent pulmonary artery resection. The technique used was an R0 resection with end-to-end anastomosis only if needed, distal control of the pulmonary artery by clamping the vein (not the artery), and no postoperative anticoagulation. RESULTS: Between October 1998 and June 6, 2006, 42 (3.2%) of 1328 patients who underwent lobectomy performed by one surgeon required resection of the pulmonary artery (38 partial, 4 circumferential) to achieve a margin-negative resection and avoid pneumonectomy. Of these, 41 had non-small cell lung cancer, and 23 (55%) had neoadjuvant chemoradiotherapy (median dose of 60 Gy). Right upper lobectomy was performed in 2 patients and a left upper lobectomy in 40. A negative bronchial and vascular margin was achieved in all. Morbidity occurred in 11 patients (atrial fibrillation in 6) and left recurrent laryngeal neurapraxia in 2. Aspiration resulted in one operative death. Follow-up (median, 48 months) showed no local recurrence on the pulmonary artery and normal blood flow through it. Five-year survival was 60%. CONCLUSIONS: Pulmonary artery resection and reconstruction to avoid pneumonectomy can be performed safely, even in a highly irradiated field. Clamping of the remaining pulmonary vein for distal control is safe and affords more room. Circumferential resection with end-to-end anastomosis of the pulmonary artery is rarely required. Partial resection is safe, does not impede blood flow, and does not compromise local recurrence rates. Postoperative anticoagulation is not needed.
BACKGROUND: We assessed our experience with partial or circumferential resection of the pulmonary artery during lobectomy. METHODS: We retrospectively reviewed a prospective electronic database of patients who underwent pulmonary artery resection. The technique used was an R0 resection with end-to-end anastomosis only if needed, distal control of the pulmonary artery by clamping the vein (not the artery), and no postoperative anticoagulation. RESULTS: Between October 1998 and June 6, 2006, 42 (3.2%) of 1328 patients who underwent lobectomy performed by one surgeon required resection of the pulmonary artery (38 partial, 4 circumferential) to achieve a margin-negative resection and avoid pneumonectomy. Of these, 41 had non-small cell lung cancer, and 23 (55%) had neoadjuvant chemoradiotherapy (median dose of 60 Gy). Right upper lobectomy was performed in 2 patients and a left upper lobectomy in 40. A negative bronchial and vascular margin was achieved in all. Morbidity occurred in 11 patients (atrial fibrillation in 6) and left recurrent laryngeal neurapraxia in 2. Aspiration resulted in one operative death. Follow-up (median, 48 months) showed no local recurrence on the pulmonary artery and normal blood flow through it. Five-year survival was 60%. CONCLUSIONS: Pulmonary artery resection and reconstruction to avoid pneumonectomy can be performed safely, even in a highly irradiated field. Clamping of the remaining pulmonary vein for distal control is safe and affords more room. Circumferential resection with end-to-end anastomosis of the pulmonary artery is rarely required. Partial resection is safe, does not impede blood flow, and does not compromise local recurrence rates. Postoperative anticoagulation is not needed.