Background: Pulmonary resections for bronchial carcinoma may sometimes require intrapericardial dissections for complete resection and due to difficulties in safe hilar dissections. We evaluated these operations presenting high surgical risks.

Methods: Twelve patients (9 men, 3 women; mean age 61.4 years; range 50 to 73 years) who underwent pulmonary resection with intrapericardial vascular ligation were evaluated with respect to surgical technique, morbidity, and mortality. Ligation was performed following vascular division and with the use of a mechanical staple. Upon completion of pneumonectomies, vascular and bronchial specimens were obtained for intraoperative frozen section analysis. Pericardial defects were repaired with primary sutures in eight patients, and with a synthetic graft in four patients.

Results: In three patients, partial resection of the left atrium was required due to tumor invasion. In two patients, tumor invasion to the superior pulmonary vein spread to its pericardial portion. T-stages of the disease were T₄ (stage IIIB) in five patients, T₃N₁ (stage IIIA) in five patients, and T₃N₀ (stage IIB) in two patients. No residual tumor was detected in vascular and bronchial specimens at frozen section analysis. Postoperative complications included cardiac arrhythmias (atrial fibrillation) in three patients, mediastinal shift in three patients, empyema in one patient, and wound infection in one patient. Perioperative mortality occurred in one patient (8.3%) due to uncontrolled hemorrhage.

Conclusion: Particular care should be taken in giving the decision for intrapericardial pneumonectomy and performing it because of its potential morbidity and mortality.

Keywords : Atrial fibrillation/etiology; heart atria/surgery; ligation; lung neoplasms/surgery; pneumonectomy/methods; pulmonary artery/pathology