Yasuo Sekine1, Yukio Saitoh2, Mitsuru Yoshino2, Eitetsu Koh3, Atsushi Hata3, Terunaga Inage2, Hidemi Suzuki3,4, Ichiro Yoshino4. 1. Department of Thoracic Surgery, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Owada-Shinden, Yachiyo, Chiba, 276-8524, Japan. sekine.yasuo@twmu.ac.jp. 2. Department of Thoracic Surgery, National Hospital Organization Chiba Medical Center, Chiba, Japan. 3. Department of Thoracic Surgery, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Owada-Shinden, Yachiyo, Chiba, 276-8524, Japan. 4. Department of Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
Abstract
PURPOSES: To evaluate vertebral artery (VA) dominancy and the risk of brain infarction in T4 lung cancer patients with tumor invasion into the subclavian artery. METHODS: We reconstructed the subclavian artery in 10 patients with T4 non-small cell lung cancer. The histological stages were IIIA in eight patients and IIIB in two patients. We evaluated the VA dominancy by performing a four-vessel study preoperatively and investigated the relationship between the methods of VA treatment and postoperative brain complications, retrospectively. RESULTS: Seven patients had a superior sulcus tumor (SST) and three had direct invasion into the mediastinum. Based on the tumor location, a transmanublial approach was used in five patients and a posterolateral hook incision was used in the other five. All subclavian artery (SA) reconstructions were done using an artificial woven graft. Preoperative angiography of the VA revealed poor development of the contralateral side in two patients. One of these patients suffered a severe brain infarction on postoperative day 2, which proved fatal. In the other patient, the VA was connected to the left SA graft by a side-to-end anastomosis and there was no postoperative brain complication. CONCLUSIONS: Preoperative SA and VA angiography is mandatory for identifying the need for VA reconstruction in lung cancer patients with major arterial invasion.
PURPOSES: To evaluate vertebral artery (VA) dominancy and the risk of brain infarction in T4 lung cancerpatients with tumor invasion into the subclavian artery. METHODS: We reconstructed the subclavian artery in 10 patients with T4 non-small cell lung cancer. The histological stages were IIIA in eight patients and IIIB in two patients. We evaluated the VA dominancy by performing a four-vessel study preoperatively and investigated the relationship between the methods of VA treatment and postoperative brain complications, retrospectively. RESULTS: Seven patients had a superior sulcus tumor (SST) and three had direct invasion into the mediastinum. Based on the tumor location, a transmanublial approach was used in five patients and a posterolateral hook incision was used in the other five. All subclavian artery (SA) reconstructions were done using an artificial woven graft. Preoperative angiography of the VA revealed poor development of the contralateral side in two patients. One of these patients suffered a severe brain infarction on postoperative day 2, which proved fatal. In the other patient, the VA was connected to the left SA graft by a side-to-end anastomosis and there was no postoperative brain complication. CONCLUSIONS: Preoperative SA and VA angiography is mandatory for identifying the need for VA reconstruction in lung cancerpatients with major arterial invasion.
Entities:
Keywords:
Lung cancer surgery; Subclavian artery; T4 cancer; Vascular reconstruction
Authors: Leonardo Rangel-Castilla; M Yashar S Kalani; Katherine Cronk; Joseph M Zabramski; Jonathan J Russin; Robert F Spetzler Journal: J Neurosurg Date: 2014-11-14 Impact factor: 5.115