PURPOSE:Lobectomy with pulmonary artery (PA) plasty is a feasible procedure to avoid pneumonectomy in locally advanced non-small cell lung cancer (NSCLC). The aim of this study was to assess the outcome and prognosis of PA plasty in NSCLC.
METHODS:We retrospectively investigated patients who underwent lobectomy with PA plasty in NSCLC. All patients were performed partial or circumferential PA resection followed by reconstruction.
RESULTS:Between June 1984 and April 2008, 84 (4.0%) of 2095 patients who underwent lobectomy or pneumonectomy were required PA plasty (65 male, 19 female; age range 40 to 84, median 67 years). During the same time, we underwent 254 (12.1%) lobectomy with bronchoplasty and 82 (3.9%) pneumonectomy. Of 84 patients examined, 53 (63.0%) had a plasty both PA and bronchus. We performed 77 partial PA resections (including 3 PA plasty with pericardial patch) and 7 circumferential PA resections. Left upper lobectomy was performed in 48 patients and a right upper lobectomy in 23 to avoid pneumonectomy. Five right middle and 8 left lower lobectomy underwent to avoid bilobectomy. Twenty-three patients had induction therapy (15 chemoradiotherapy and 8 chemotherapy alone). Tumor histology was squamous cell carcinoma (SQ) in 54 (64.3%) and non-SQ in 30 (including 24 adenocarcinoma). Morbidity occurred in 24 patients (28.6%). There was one operative death (1.2%) caused by bleeding during re-operation of bronchostenosis. We had no specific complications with PA plasty. Five-year survival was 38.3% for all patients, 51.8, 47.8 and 23.9% for p-stage I, II and III, respectively.
CONCLUSION:PA plasty can undergo safely and should be performed in stage I, II, and III. Morbidity, mortality and survival do not differ from what is reported for lobectomy.
CLINICAL IMPLICATIONS:Our data suggests that PA plasty is a useful option for treatment in locally advanced NSCLC.
DISCLOSURE:Koichiro Iwanaga, No Financial Disclosure Information; No Product/Research Disclosure Information