Venuta Federico, Ciccone Anna Maria, Anile Marco, Ibrahim Mohsen, De Giacomo Tiziano, Coloni Giorgio F, Rendina Erino A
Department of Thoracic Surgery, Policlinico Umberto I, University of Rome Sapienza, Via le del Policlinico 155, Rome, Italy.
J Thorac Cardiovasc Surg. 2009 Nov;138(5):1185-91. doi: 10.1016/j.jtcvs.2009.07.043. Epub 2009 Sep 9.
Reconstruction of the pulmonary artery in association with lung resection is technically feasible with low morbidity and mortality. To assess long-term outcome, we report our 20-year experience.
Between 1989 and 2008, we performed pulmonary artery reconstruction in 105 patients with non-small cell lung cancer (tangential resections not included). Twenty-seven patients received induction therapy. We performed 47 pulmonary artery sleeve resections, 55 reconstructions by pericardial patch (with 3 left pneumonectomies under cardiopulmonary bypass), and 3 by pericardial conduit. In 65 patients, a bronchial sleeve resection was associated; in 6 cases superior vena caval reconstruction was also required. Fifteen patients had stage IB disease, 37 stage II, 31 IIIA, and 22 IIIB. Sixty-one patients had epidermoid carcinoma, and 38 adenocarcinoma. Mean follow-up was 46 +/- 40 months.
The procedure-related complications were 1 pulmonary artery thrombosis requiring completion pneumonectomy and 1 massive hemoptysis leading to death (operative mortality, 0.95%); 28 patients had other complications, with the most frequent prolonged air leakage. Overall 5-year survival was 44%. Five- and 10-year survivals for stages I and II versus stage III were, respectively, 60% versus 28% and 25% versus 12%. Five-year survivals were 52.6% for N0 and N1 nodal involvement versus 20% for N2; 10-year survivals were 28% versus 3%. Multivariate analysis yielded induction therapy, N2 status, adenocarcinoma, and isolated pulmonary artery reconstruction as negative prognostic factors.
Pulmonary artery reconstruction is safe, with excellent long-term survival. Our results support this technique as an effective option for patients with lung cancer.
肺动脉重建联合肺切除术在技术上是可行的，发病率和死亡率较低。为评估长期疗效，我们报告了我们20年的经验。
1989年至2008年期间，我们对105例非小细胞肺癌患者（不包括楔形切除术）进行了肺动脉重建。27例患者接受了诱导治疗。我们进行了47例肺动脉袖状切除术，55例采用心包补片重建（其中3例在体外循环下行左全肺切除术），3例采用心包管道重建。65例患者同时进行了支气管袖状切除术；6例患者还需要进行上腔静脉重建。15例患者为ⅠB期疾病，37例为Ⅱ期，31例为ⅢA期，22例为ⅢB期。61例患者为表皮样癌，38例为腺癌。平均随访时间为46±40个月。
与手术相关的并发症包括1例肺动脉血栓形成，需行全肺切除术，1例大量咯血导致死亡（手术死亡率为0.95%）；28例患者出现其他并发症，最常见的是持续性漏气。总体5年生存率为44%。Ⅰ期和Ⅱ期与Ⅲ期患者的5年和10年生存率分别为60%对28%和25%对12%。N0和N1淋巴结受累患者的5年生存率为52.6%，而N2患者为20%；10年生存率分别为28%对3%。多因素分析显示诱导治疗、N2状态、腺癌和单纯肺动脉重建为负面预后因素。
肺动脉重建是安全的，长期生存率良好。我们的结果支持将该技术作为肺癌患者的一种有效选择。
