Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung, 80756, Taiwan.
Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 80756, Taiwan.
BMC Surg. 2024 Oct 26;24(1):334. doi: 10.1186/s12893-024-02632-8.
Resection of intrathoracic tumor with cardiopulmonary bypass (CPB) remains a relatively under-reported intervention in literature, and its role in managing locally advanced mediastinal and lung cancers is a topic of ongoing debate. Our aim was to review our experience and assess the role of CPB for treating locally advanced mediastinal and lung cancers.
Between 2015 and 2020, this study initially included 10 patients with primary locally advanced thoracic malignancies with apparent adjacent cardiovascular invasion demonstrated by thoracic imaging scans. Operation was performed based on a multidisciplinary tumor board consensus. Eventually, 8 patients (3 primary lung cancers and 5 mediastinal cancers) received either salvage or elective resection with CPB; two completed surgery without requiring CPB.
Regarding the extent of adjacent structure involvement, 4 patients presented with involvement of the superior vena cava (SVC), 1 involved the right atrium (RA), 2 involved the SVC and RA, and 1 involved the SVC, the origin of main pulmonary artery, and the ascending aorta. Thirty-day mortality occurred in two of three patients receiving salvage surgery due to respiratory insufficiency. With the long-term follow-up, one patient died of recurrence 25 months postoperatively, one survived with recurrence 30 months postoperatively, and four were alive without recurrence for 35, 36, 49, and 107 months after operations.
In certain patients, particularly for elective surgical candidates rather than salvage resection, CPB allows for extended resection of locally advanced thoracic cancers with acceptable perioperative safety and survival.
体外循环（CPB）下切除胸腔内肿瘤在文献中仍然是一个相对较少报道的干预措施，其在治疗局部晚期纵隔和肺癌中的作用仍存在争议。我们旨在回顾我们的经验，并评估 CPB 在治疗局部晚期纵隔和肺癌中的作用。
在 2015 年至 2020 年期间，本研究最初纳入了 10 例经胸部影像学检查显示明显相邻心血管侵犯的原发性局部晚期胸部恶性肿瘤患者。手术是根据多学科肿瘤委员会的共识进行的。最终，8 例患者（3 例原发性肺癌和 5 例纵隔癌）接受了 CPB 下的挽救性或选择性切除术；2 例患者完成了手术，无需 CPB。
在相邻结构受累的程度方面，4 例患者上腔静脉（SVC）受累，1 例右心房（RA）受累，2 例 SVC 和 RA 受累，1 例 SVC、主肺动脉起源和升主动脉受累。3 例接受挽救性手术的患者中有 2 例因呼吸功能不全而在 30 天内死亡。在长期随访中，1 例患者在术后 25 个月死于复发，1 例患者在术后 30 个月时仍存活但有复发，4 例患者在术后 35、36、49 和 107 个月时无复发且存活。
在某些患者中，特别是对于选择性手术候选者而不是挽救性切除术，CPB 允许对局部晚期胸部癌症进行可接受的围手术期安全性和生存的广泛切除。
