Domenico Galetta1, Alessandro Borri2, Roberto Gasparri2, Francesco Petrella2, Lorenzo Spaggiari3. 1. Division of Thoracic Surgery, European Institute of Oncology, Milan. Electronic address: mimgaletta@yahoo.com. 2. Division of Thoracic Surgery, European Institute of Oncology, Milan. 3. Division of Thoracic Surgery, European Institute of Oncology, Milan; University of Milan School of Medicine, Milan, Italy.
Abstract
BACKGROUND: Pulmonary artery (PA) reconstruction for lung cancer is technically feasible with low morbidity and mortality. We assessed our experience with partial or circumferential resection of the PA during lung resection. METHODS: Between 1998 and 2013, we performed PA angioplasty in 150 patients with lung cancer. Partial PA resection was performed in 146 patients. PA reconstruction was performed by running suture in 113 patients and by using a pericardial patch in 33. A circumferential PA resection was performed in 4 patients, and reconstruction was made with polytetrafluoroethylene and by a custom-made bovine pericardial conduit. Bronchial sleeve resection was associated in 56 patients. Stage I disease was present in 32 patients, stage II in 43, stage IIIA in 51, and stage IIIB in 17. Seventy-five patients received induction chemotherapy, and 7 patients had a complete response. RESULTS: Thirty-day mortality was 3.3% (n = 5); two of these patients died of a massive hemoptysis. Pulmonary complications occurred in 33 patients, cardiac in 28, and air leaks in 17. Overall 5-year and 10-year survival was 50% and 39%, respectively. Survival at 5 and 10 years for stages I and II vs stage III was, respectively, 66% vs 32% and 56% vs 20% (p < 0.0001). Five-year survival was 61% for N0 and N1 nodal involvement vs 28% for N2, and the respective 10-year survival was 45% vs 28% (p = 0.001). Induction chemotherapy did not influence survival. Multivariate analysis yielded advanced stage, N2 status, and squamous cell carcinoma as negative prognostic factors. CONCLUSIONS: PA reconstruction is safe, with excellent long-term survival. Our results support this technique as an effective option to pneumonectomy for patients with lung cancer.
BACKGROUND: Pulmonary artery (PA) reconstruction for lung cancer is technically feasible with low morbidity and mortality. We assessed our experience with partial or circumferential resection of the PA during lung resection. METHODS: Between 1998 and 2013, we performed PA angioplasty in 150 patients with lung cancer. Partial PA resection was performed in 146 patients. PA reconstruction was performed by running suture in 113 patients and by using a pericardial patch in 33. A circumferential PA resection was performed in 4 patients, and reconstruction was made with polytetrafluoroethylene and by a custom-made bovine pericardial conduit. Bronchial sleeve resection was associated in 56 patients. Stage I disease was present in 32 patients, stage II in 43, stage IIIA in 51, and stage IIIB in 17. Seventy-five patients received induction chemotherapy, and 7 patients had a complete response. RESULTS: Thirty-day mortality was 3.3% (n = 5); two of these patients died of a massive hemoptysis. Pulmonary complications occurred in 33 patients, cardiac in 28, and air leaks in 17. Overall 5-year and 10-year survival was 50% and 39%, respectively. Survival at 5 and 10 years for stages I and II vs stage III was, respectively, 66% vs 32% and 56% vs 20% (p < 0.0001). Five-year survival was 61% for N0 and N1 nodal involvement vs 28% for N2, and the respective 10-year survival was 45% vs 28% (p = 0.001). Induction chemotherapy did not influence survival. Multivariate analysis yielded advanced stage, N2 status, and squamous cell carcinoma as negative prognostic factors. CONCLUSIONS: PA reconstruction is safe, with excellent long-term survival. Our results support this technique as an effective option to pneumonectomy for patients with lung cancer.