ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Pulmonary artery resections and reconstructions for lung cancer treatment: an anatomical-technical analysis and survival relationships
Alper Toker, Adalet Demir, Erkan Kaba, Murat Kapdağlı, Sedat Ziyade, Başak Saraçoğlu, Suat Erus, Berker Özkan, Serhan Tanju
Department of Thoracic Surgery, İstanbul University School of Medicine, İstanbul, Turkey
DOI : 10.5606/tgkdc.dergisi.2015.9467
Background: This study aims to report the results of pulmonary arterial (PA) resections and reconstructions with either a patch or end-to-end anastomosis for lung cancer which are currently rarely used.

Methods: Between January 2005 and January 2012, 712 non-small cell lung cancer patients underwent surgery of which 32 (26 males, 6 females; mean age 62±8 years; range 39 to 80 years) had lobectomy and major reconstructive surgery for PA (14 partial, including four PA reconstructions with an autologous pericardial patch and 10 PA reconstructions with a polytetraflouroethylene graft and 18 circumferential).

Results: The median survival was 48±8 months. Five and seven-year survival rates were 27% and 9% respectively. No operative mortality was seen. Morbidity rates were 41% (minor 31% and major 10%). All patients with a right-sided resection had also a bronchial sleeve resections with a rate of 59% in the left lung (p=0.03). The rate of double sleeve resection was 47%. The median and five-year survival rates were 60±36 months and 37% in the arterial patch plasty operations respectively, whereas it was 43±13 months and 22% in circumferential resections and end-to-end anastomosis patients, respectively (p=0.38). There was no statistically significant difference in the complication rate between the circumferential resections with patch plasty operations and end-to-end anastomosis (p=0.808). Five-year survival rate was 16% in double sleeve resections and 48% in others (p=0.282). Univariate analysis of survival demonstrated no significant differences in terms of age (p=0.185), side (p=0.527), neoadjuvant treatment (p=279), N status (p=0.878), type of adjuvant treatment (p=0.978) and metastasis development (p=0.471). Female gender (p=0.05), adjuvant treatment (p=0.001) and development of postoperative complications (p=0.038) were identified as positive predictors for long-term survival.

Conclusion: Pulmonary arterial resections and reconstructions to prevent pneumonectomy are feasible and effective surgical procedures with acceptable morbidity and mortality rates. Female gender, postoperative adjuvant oncological treatment and non-complicated postoperative course appear to be potential influencing factors on long-term survival.

Keywords : Lobectomy; lung cancer; pulmonary artery; sleeve resection
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