Permanent Cerebral Bypass Approach for Lung Cancer Resection with Aortic Arch Invasion
Department of Thoracic Surgery, Narita Red-Cross Hospital, Narita, Japan.The Thoracic and Cardiovascular Surgeon (Impact Factor: 0.98). 07/2011; 59(6):378-80. DOI: 10.1055/s-0031-1280069
We report a case of a 54-year-old man with T4N0M0 non-small cell lung cancer directly invading the thoracic wall and aortic arch. He underwent neoadjuvant chemotherapy followed by en bloc resection of the tumor, lung, chest wall and aortic arch. Perfusion was maintained through femoral-femoral cardiopulmonary bypass, with permanent bypass to the arch vessels to avoid separate extracorporeal cerebral circulation. Total reconstructions of the chest wall and aortic arch were completed without the need for cardiac arrest. The final pathological diagnosis was squamous cell carcinoma, T4N0M0. The patient was discharged without major complications and has been free of disease for 20 months postoperatively.
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ABSTRACT: Introduction pT4 is a group of miscellaneous tumors: our goal was to revisit their surgical reality. Methods The different characteristics and prognostic factors of lung pT4 (n = 403) were analysed according to three subgroups: G1 – by direct extension; G2 – by nodule in other ipsilateral lobe; G3 – because of both. Results There were 332 males and 71 females mean aged 61.5 years. Surgery [exploratory: 89 (22.1 %), lobectomy: 149 (37 %), pneumonectomy: 169 (41.9 %)] was followed by 26 postoperative deaths (6.5 %), 82 complications (20.3 %) and concerned few pN0 (47.6 %). G1 (n = 196) and G3 (n = 53) were not different. By comparison with them, G2 (n = 53) were mainly females (24\13 %), with less explorative thoracotomy (2.6\34 %), more complete R0 resections (77\29 %), less pneumonectomy (31\47 %), more small sized tumors (mean: 37\57 mm), more adenocarcinoma (67\32 %), more N0 tumors (48\31.7 %) and stages IIIA disease (46.7\56 %). G2 5-year survival rates were higher (G2: 22 %; G1: 13 %; G3: 15 %); G1 rates depended of the invaded structure (20.9 % for the vertebra down to 0 % for the esophagus and carina). pN2 rates were not very high but not different between groups (G1: 13.6 %; G2: 15.6 %; G3: 14.3 %; P = 0.52). Multivariate analysis demonstrated completeness and type of resection, stage and age as independent factors of prognosis. Conclusion Surgery for pT4 is justified provided rigorous selection of extension forms. However, assimilating extension and ipsilateral lobe nodule in a same group does not obey to surgical reality.
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