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Federico Venuta
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Ann Thorac Surg 1999;68:995-1001
© 1999 The Society of Thoracic Surgeons

Original Articles: General Thoracic

Sleeve resection and prosthetic reconstruction of the pulmonary artery for lung cancer

Erino A. Rendina, MDa, Federico Venuta, MDa, Tiziano De Giacomo, MDa, Anna Maria Ciccone, MDa, Marco Moretti, MDa, Giovanni Ruvolo, MDa, Giorgio Furio Coloni, MDa

a Department of Thoracic Surgery "La Sapienza" University of Rome, Rome, Italy

Address reprint requests to Dr Rendina, Department of Thoracic Surgery, University "La Sapienza," 00161 Rome, Italy

Presented at the Thirty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Antonio TX, Jan 25–27, 1999.

Abstract

Background. Lobectomy associated with reconstruction of the pulmonary artery (PA) is a technically feasible alternative to pneumonectomy in patients with lung cancer. However, concern about postoperative complications and long-term survival limited its acceptance so far.

Methods. Between 1989 and 1996, we performed a PA reconstruction in 52 patients (41 men, 11 women; age range 35 to 75 years, mean 60 years) with lung cancer. Eleven patients had induction chemotherapy. We performed 15 PA sleeve resections, 34 PA reconstructions by a pericardial patch, and three PA reconstructions by a pericardial conduit, associated with a bronchial sleeve lobectomy or bilobectomy (33), or with standard lobectomy (19). Immediate and long-term postoperative evaluation included spirometry, echocardiography, perfusion lung scans, computed tomography, and PA angiography. The follow-up ranged between 27 and 96 months and is complete for all patients.

Results. We had one specific postoperative complication (PA thrombosis) and no mortality. Perfusion scans and PA angiography were normal in all but the 1 patient having thrombosis. Mean forced expiratory volume (FEV) in 1 s and forced vital capacity (FVC) were, respectively, 72% and 80% preoperatively, 65% and 76% 1 month after surgery, and then they plateaued at 70% and 78% after 6 months. Echocardiography showed patterns in the normal range and normal estimates of PA pressures in all but 2 patients. Five-year survival was 38.3% for the entire group, 18.6% for stages IIIA and B, and 64.4% for stages I and II.

Conclusions. Morbidity, mortality, and functional data do not differ from what is currently reported for standard lobectomy. Long-term survival is in line with that reported for standard resection. These data support PA reconstruction as a viable option in the treatment of lung cancer.




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