Lobectomy with tangential pulmonary artery resection without regard to pulmonary function

Background. Non-small cell carcinoma of the lung invading the pulmonary art ery (PA) has traditionally been treated by pneumonectomy. Although PA resec tion and reconstruction (PAR) has begun to gain acceptance, previous series of PAR by the simplest technique of tangential excision and primary repair have been unfavorable. We have maintained a policy of performing PAR prefe rentially whenever anatomically feasible, and usually this has been possibl e by tangential excision and primary repair. This study sought to determine if this approach is sound. Methods. Retrospective clinical and pathologic review. Results. Thirty-three PARs were performed from 1992 to 1999. The patients, followed 6 to 65 months (mean 25), were aged 36 to 80 years (mean 61), and their tumors were pathologic stage IB (n = 7), IIB (n = 13), IIIA (n = 9), and IIIB (n = 4). The mean preoperative forced expiratory volume in 1 secon d was 70% predicted. The procedures included 14 bronchial sleeve lobectomie s with PAR and 19 simple lobectomies with PAR. The PARs were performed with out heparinization and included 19 tangential excisions with primary closur e, 11 larger tangential excisions with pericardial patch closure, and 3 sle eve resections. There were no operative deaths and 2 (6.1%) early major com plications, all unrelated to the PAR. Thirteen patients (39%) had early min or complications. Four-year Kaplan-Meier survival was 48.3% for stages I/II and 45% for stage III. Ipsilateral, central, intrathoracic recurrence occu rred in 3 patients (9.1%). Conclusions. These data are not dramatically different from those reported for standard resections. Although the numbers are small, the results sugges t that lobectomy with PAR by tangential excision is an acceptable alternati ve to pneumonectomy whenever anatomically possible. (Ann Thorac Surg 2000;7 0:234-9) (C) 2000 by The Society of Thoracic Surgeons.