Boston - American Association for Thoracic Surgery

89 TH ANNUAL MEETING MAY 9–MAY 13, 2009BOSTON, MASSACHUSETTS20. Reconstruction of the Pulmonary Artery for Lung Cancer: LongTerm ResultsFederico Venuta, 1* Anna Maria Ciccone, 2† Marco Anile, 1 Mohsen Ibrahim, 2Francesco Pugliese, 1 Domenico Massullo, 2 Tiziano De Giacomo, 1Giorgio F. Coloni, 1 Erino A. Rendina 2*1. University Sapienza of Rome – Policlinico Umberto I, Rome, Italy; 2. UniversitySapienza of Rome – Ospedale S. Andrea, Rome, ItalyInvited Discussant: Shaf KeshavjeeOBJECTIVE: Lobectomy with resection and reconstruction of the pulmonaryartery (PA) is technically feasible with low morbidity and mortality; it is a valuablealternative to pneumonectomy with clear functional advantages and oncologicalreliability. In order to assess long term results, we hereby report our 20-year experiencewith 105 consecutive patients.METHODS: Between 1989 and 2008 we performed PA reconstruction in 105patients (87 men, 18 women; mean age 62 ± 10.5 years) with lung cancer; tangentialresections are not included in this series. The mean preoperative FEV1 was 76.1% ±14%. Twenty-seven patients (25.7%) received induction therapy. We performed 47sleeve resections (44.8%), 55 (52.3%) reconstructions by a pericardial patch (3 associatedwith pneumonectomy under cardiopulmonary by pass) and 3 (2.9%) by apericardial conduit. The surgical technique was uniform throughout the studyperiod. In 65 patients (62%) PA reconstruction was associated with bronchialsleeve resection; in 6 cases also Superior Vena Cava reconstruction was required.Sixteen patients were at stage IB, 36 were stage II, 29 IIIA and 24 IIIB. Sixty-onepatients had epidermoid carcinoma and 38 had adenocarcinoma. The mean follow-upwas 42.2 ± 40 months.RESULTS: The procedure-related major complications were 1 PA thrombosisrequiring completion pneumonectomy and one massive hemoptysis leading todeath (28th postoperative day; operative mortality: 1 patient, 0.95%); 28 patientsexperienced other complications; the most frequent (10 patients) was prolongedair leaks. Overall 5-year survival was 44.3%. Five and ten-year survival for stage I-IIand III was respectively 57.1% and 27.1%; and 31.1% and 6.2%. At multivariateanalysis induction therapy, stage, histology and patch reconstruction were negativeprognostic factors.CONCLUSION: PA reconstruction is safe and yields excellent long term survival.Our results in a large series of patients support this technique as a viable and effectiveoption for patients with lung cancer.* AATS Member† Graham Memorial Traveling Fellowship 2001–2002106