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Marc de Perrot
Elie Fadel
Sacha Mussot
Alain Chapelier
Philippe Dartevelle
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Right arrow Lung - cancer

Ann Thorac Surg 2005;79:1691-1696
© 2005 The Society of Thoracic Surgeons

Original articles: General thoracic

Resection of Locally Advanced (T4) Non-Small Cell Lung Cancer With Cardiopulmonary Bypass

Marc de Perrot, MD, Elie Fadel, MD*, Sacha Mussot, MD, Angela de Palma , MD, Alain Chapelier , MD, Philippe Dartevelle, MD

Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France

Accepted for publication October 14, 2004.

* Address reprint requests to Dr Dartevelle, Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie-Lannelongue, 133 Avenue de la Résistance, 92350 Le Plessis-Robinson, France (E-mail: pdartevelle{at}ccml.com).

BACKGROUND: Resection of T4 non-small cell lung cancer (NSCLC) on cardiopulmonary bypass (CPB) has rarely been reported in the literature. Hence, we have reviewed our experience in the role of CPB for the surgical treatment of locally advanced NSCLC.

METHODS: All patients undergoing lung resection for bronchogenic carcinoma on CPB in our institution between January 1998 and June 2004 were reviewed.

RESULTS: Seven patients underwent lung resections on CPB for bronchogenic carcinoma during the study period. Cardiopulmonary bypass was performed for tumors invading the subclavian artery down to the aortic arch (n = 2), the descending aorta (n = 1), or the origin of the left pulmonary artery with the left atrium (n = 2). All patients were discharged home after 9 to 21 days (median, 15 days). In the long term, 2 patients are alive without recurrence 17 and 25 months after their operations, and 3 are alive with recurrence 8, 13, and 54 months postoperatively. Two additional patients required CPB while undergoing carinal resection for difficulty ventilating the left lung. Both patients had a difficult postoperative course, but were eventually discharged from hospital. One patient died without recurrence 6 months later, and the other is alive without recurrence after 72 months.

CONCLUSIONS: This study confirms the safety of CPB for NSCLC invading the great vessels and/or the left atrium in well-selected patients, and its utility when pulmonary edema develops during carinal resection. Further studies, however, are required to confirm long-term survival.




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