Methods: Between January 2010 and January 2023, a total of 50 patients (47 males, 3 females; mean age: 60.5±8 years; range, 43 to 83 years) who underwent lobectomy and pulmonary artery resection and reconstruction due to invasion of the pulmonary artery were retrospectively analyzed. Partial resection was performed in 45 patients. Circular pulmonary artery resection was performed in the remaining five patients. Demographic data of the patients, histopathology, lymph node metastasis, tumor size, T status, stage, comorbidity, neoadjuvant treatment and adjuvant treatment were recorded. Survival analysis was performed.

Results: All patients were operated via thoracotomy. Except for those who underwent tangential resection with a stapler, the proximal and distal parts of the artery were resected by placing a Satinsky clamp. In 35 (70%) patients, pulmonary artery invasion originated from the tumor itself, while in 15 (30%) patients, it originated from the lymph node. The five-year survival rate was 46%, with an operative mortality rate of 6% and a morbidity rate of 24%. Cox regression analysis identified neoadjuvant treatment and N2 disease as statistically significant factors influencing survival. The median disease-free survival time for all patients was 27.9 (range, 4.5 to 51.2) months. Operated side, neoadjuvant treatment, N status, reason for pulmonary artery resection, sleeve resection and type of pulmonary artery resection showed statistically significant differences in the Kaplan-Meier analysis.

Conclusion: Our study results suggest that pulmonary artery resections and reconstructions are feasible with acceptable morbidity and mortality rates. Neoadjuvant treatment, N2 disease, and the reason and type of pulmonary artery resection are potential factors influencing long-term survival. Pulmonary artery reconstruction is safe in experienced clinics with promising long-term survival outcomes.