Department of Thoracic Surgery, Sapienza University, Sant'Andrea Hospital, Rome, Italy.
Department of Thoracic Surgery, Sapienza University, Sant'Andrea Hospital, Rome, Italy.
J Thorac Cardiovasc Surg. 2024 Apr;167(4):1481-1489. doi: 10.1016/j.jtcvs.2023.07.041. Epub 2023 Aug 2.
We report a single-center experience of resection and reconstruction of the heart and aorta infiltrated by lung cancer in order to prove that involvement of these structures is no longer a condition precluding surgery.
Twenty-seven patients underwent surgery for lung cancer presenting full-thickness infiltration of the heart (n = 6) or the aorta (n = 18) and/or the supra-aortic branches (subclavian n = 3). Cardiac reconstruction was performed in 6 patients (5 atrium, 1 ventricle), with (n = 4) or without (n = 2) cardiopulmonary bypass, using a patch prosthesis (n = 4) or with deep clamping and direct suture (n = 2). Aortic or supra-aortic trunk reconstruction (n = 21) was performed using a heart-beating crossclamping technique in 14 cases (8 patch, 4 conduit, 2 direct suture), or without crossclamping by placing an endovascular prosthesis before resection in 7 (4 patch, 3 omental flap reconstruction). Neoadjuvant chemotherapy was administered in 13 patients, adjuvant therapy in 24.
All resections were complete (R0). Nodal staging of lung cancer was N0 in 14 cases, N1 in 10, N2 in 3. No intraoperative mortality occurred. Major complication rate was 14.8%. Thirty-day and 90-day mortality rate was 3.7%. Median follow-up duration was 22 months. Recurrence rate is 35.4% (9/26: 3 loco-regional, 6 distant). Overall 3- and 5-year survival is 60.9% and 40.6%, respectively.
Cardiac and aortic resection and reconstruction for full-thickness infiltration by lung cancer can be performed safely with or without cardiopulmonary bypass and may allow long-term survival of adequately selected patients.
我们报告了一个单中心的经验，切除和重建心脏和主动脉浸润的肺癌，以证明这些结构的参与不再是手术的禁忌条件。
27 例肺癌患者行手术治疗，表现为心脏（n=6）或主动脉（n=18）和/或主动脉上分支（锁骨下 n=3）全层浸润。6 例患者行心脏重建（5 例心房，1 例心室），其中 4 例患者行体外循环（CPB）（n=4），2 例患者不行 CPB（n=2），使用补片假体（n=4）或深夹闭和直接缝合（n=2）。14 例患者采用心脏跳动式阻断技术行主动脉或主动脉干重建（n=21），其中 8 例使用补片（n=8），4 例使用移植物（n=4），2 例直接缝合（n=2），7 例患者在切除前放置血管内假体，不进行阻断（n=7），其中 4 例使用补片（n=4），3 例使用大网膜瓣重建（n=3）。13 例患者接受新辅助化疗，24 例患者接受辅助治疗。
所有切除均为完全性（R0）。肺癌淋巴结分期 N0 14 例，N1 10 例，N2 3 例。无术中死亡。主要并发症发生率为 14.8%。30 天和 90 天死亡率分别为 3.7%。中位随访时间为 22 个月。复发率为 35.4%（9/26：3 例局部复发，6 例远处转移）。总 3 年和 5 年生存率分别为 60.9%和 40.6%。
对于肺癌全层浸润的心脏和主动脉切除重建可在有或无体外循环的情况下安全进行，可能使适当选择的患者获得长期生存。
