Sleeve resection and prosthetic reconstruction of the pulmonary artery forlung cancer

Background. Lobectomy associated with reconstruction of the pulmonary arter y (PA) is a technically feasible alternative to pneumonectomy in patients w ith lung cancer. However, concern about postoperative complications and lon g-term survival limited its acceptance so far. Methods. Between 1989 and 1996, we performed a PA reconstruction in 52 pati ents (41 men, 11 women; age range 35 to 75 years, mean 60 years) with lung cancer. Eleven patients had induction chemotherapy. We performed 15 PA slee ve resections, 34 PA reconstructions by a pericardial patch, and three PA r econstructions by a pericardial conduit, associated with a bronchial sleeve lobectomy or bilobectomy (33), or with standard lobectomy (19). Immediate and long-term postoperative evaluation included spirometry, echocardiograph y, perfusion lung scans, computed tomography, and PA angiography. The follo w-up ranged between 27 and 96 months and is complete for all patients. Results. We had one specific postoperative complication (PA thrombosis) and no mortality. Perfusion scans and FA angiography were normal in all but th e 1 patient having thrombosis. Mean forced expiratory volume (FEV) in Is an d forced vital capacity (FVC) were, respectively, 72% and 80% preoperativel y, 65% and 76% 1 month after surgery, and then they plateaued at 70% and 78 % after 6 months. Echocardiography showed patterns in the normal range and normal estimates of PA pressures in all but 2 patients. Five-year survival was 38.3% for the entire group, 18.6% for stages IIIA and B, and 62.4% for stages I and II. Conclusions. Morbidity, mortality, and functional data do not differ from w hat is currently reported for standard lobectomy. Long-term survival is in line with that reported for standard resection. These data support PA recon struction as a viable option in the treatment of lung cancer. (Ann Thorac S urg 1999;68:995-1002) (C) 1999 by The Society of Thoracic Surgeons.