Galetta Domenico, Borri Alessandro, Gasparri Roberto, Petrella Francesco, Spaggiari Lorenzo
Division of Thoracic Surgery, European Institute of Oncology, Milan.
Division of Thoracic Surgery, European Institute of Oncology, Milan.
Ann Thorac Surg. 2015 Oct;100(4):1196-202; discussion 1202. doi: 10.1016/j.athoracsur.2015.04.124. Epub 2015 Jul 21.
Pulmonary artery (PA) reconstruction for lung cancer is technically feasible with low morbidity and mortality. We assessed our experience with partial or circumferential resection of the PA during lung resection.
Between 1998 and 2013, we performed PA angioplasty in 150 patients with lung cancer. Partial PA resection was performed in 146 patients. PA reconstruction was performed by running suture in 113 patients and by using a pericardial patch in 33. A circumferential PA resection was performed in 4 patients, and reconstruction was made with polytetrafluoroethylene and by a custom-made bovine pericardial conduit. Bronchial sleeve resection was associated in 56 patients. Stage I disease was present in 32 patients, stage II in 43, stage IIIA in 51, and stage IIIB in 17. Seventy-five patients received induction chemotherapy, and 7 patients had a complete response.
Thirty-day mortality was 3.3% (n = 5); two of these patients died of a massive hemoptysis. Pulmonary complications occurred in 33 patients, cardiac in 28, and air leaks in 17. Overall 5-year and 10-year survival was 50% and 39%, respectively. Survival at 5 and 10 years for stages I and II vs stage III was, respectively, 66% vs 32% and 56% vs 20% (p < 0.0001). Five-year survival was 61% for N0 and N1 nodal involvement vs 28% for N2, and the respective 10-year survival was 45% vs 28% (p = 0.001). Induction chemotherapy did not influence survival. Multivariate analysis yielded advanced stage, N2 status, and squamous cell carcinoma as negative prognostic factors.
PA reconstruction is safe, with excellent long-term survival. Our results support this technique as an effective option to pneumonectomy for patients with lung cancer.
肺癌的肺动脉（PA）重建在技术上是可行的，发病率和死亡率较低。我们评估了肺切除术中PA部分或环形切除的经验。
1998年至2013年期间，我们对150例肺癌患者进行了PA血管成形术。146例患者进行了PA部分切除术。113例患者通过连续缝合进行PA重建，33例患者使用心包补片进行重建。4例患者进行了环形PA切除，并用聚四氟乙烯和定制的牛心包导管进行重建。56例患者同时进行了支气管袖状切除术。32例患者为Ⅰ期疾病，43例为Ⅱ期，51例为ⅢA期，17例为ⅢB期。75例患者接受了诱导化疗，7例患者完全缓解。
30天死亡率为3.3%（n = 5）；其中2例患者死于大量咯血。33例患者发生肺部并发症，28例发生心脏并发症，17例发生漏气。总体5年和10年生存率分别为50%和39%。Ⅰ期和Ⅱ期与Ⅲ期的5年和10年生存率分别为66%对32%和56%对20%（p < 0.0001）。N0和N1淋巴结受累患者的5年生存率为61%，N2患者为28%，相应的10年生存率为45%对28%（p = 0.001）。诱导化疗不影响生存率。多因素分析显示晚期、N2状态和鳞状细胞癌为负性预后因素。
PA重建是安全的，长期生存率良好。我们的结果支持该技术作为肺癌患者肺切除术的有效选择。
