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Surgery for T4 lung cancer invading the thoracic aorta: Do we push the limits?
Author(s) -
Marulli Giuseppe,
Rendina Erino A.,
Klepetko Walter,
Perkmann Reinhold,
Zampieri Davide,
Maurizi Giulio,
Klikovits Thomas,
Zaraca Francesco,
Venuta Federico,
Perissinotto Egle,
Rea Federico
Publication year - 2017
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.24784
Subject(s) - medicine , lung cancer , surgery , thoracic aorta , aorta , lung , cardiothoracic surgery , pneumonectomy
Background Few investigators have described en bloc resection of non‐small cell lung cancer (NSCLC) invading the aorta. Aim of Study Analysis of outcome and prognostic factors for en bloc resections of NSCLC invading the aorta. Methods Thirty‐five patients (27 males, 8 females; mean age 63 ± 8.6 years) were operated between 1994 and 2015 in four European Centers. Histology: 12 (34.3%) squamous cell carcinoma, and 6 (17.1%) undifferentiated/large cell carcinoma. The site of aortic infiltration was the descending thoracic aorta in 24 (68.6%) patients, the aortic arch in 9 (25.7%), and the aortic arch and supraortic trunks in 2 (5.7%). Results Lung resection consisted of pneumonectomy in 19 (54.3%) patients and lobectomy in 16 (45.7%). Aortic resection management was undertaken by endograft positioning (37.1%), subadventitial dissection (37.1%), cardiopulmonary/aorto‐aortic bypass (17.2%), and direct clamping (8.6%). A tubular graft replacement was carried out in five cases, a synthetic patch repair in 6. Mortality was 2.9%, morbidity 37.1%. Patients undergoing pneumonectomy had a significantly higher morbidity rate compared with lobectomy (52% vs 18.7%; P = 0.003), although patients managed with aortic endografting had a lower complication rate. Median overall and disease‐free survival rates were 31.3 and 22.2 months, respectively. Gender and site of aortic infiltration were independent prognostic factors. Conclusions Resection of NSCLC combined with an infiltrated aorta is a challenging procedure that can be performed with reasonable morbidity and mortality in highly selected patients.