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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
AMERICAN ASSOCIATION FOR THORACIC SURGERY21. Tracheal Sleeve Pneumonectomy for Lung Cancer After InductionChemotherapyDomenico Galetta, Piergiorgio Solli, Giulia Veronesi, Alessandro Borri,Roberto Gasparri, Francesco Petrella, Lorenzo SpaggiariDivision of Thoracic Surgery, European Institute of Oncology, Milan, ItalyInvited Discussant: Cameron D. WrightOBJECTIVE: Non-small cell lung cancer (NSCLC) less than 2 cm from the carinaor invading the tracheo-bronchial angle, formerly considered inoperable, may beamenable to an “extended” resection (tracheal sleeve pneumonectomy – TSP). Inthese patients the role of induction chemotherapy (IC) and their effects on morbidityand mortality are unclear. We evaluated the surgical results and the long-termoutcome of patients who underwent TSP for locally advanced NSCLC after IC.MONDAYAfternoonMETHODS: From September 1998 to September 2008, 29 patients (19 men;median age of 58 years) with NSCLC of the carinal or tracheo-bronchial anglereceived induction chemotherapy (cisplatin based polichemotherapy) after mediastinoscopy.Patients with disease judged to be resectable at restaging underwentsurgery.RESULTS: All patients were available for re-staging. No complete response wasobserved. Twelve patients (41.4%) had a progression disease. Partial response ratewas 41.4% (n = 12), and stable disease 17.2% (n = 5). All patient with partialresponse and stable disease (n = 17, all with pN2) underwent surgery. Superiorvena cava was involved and resected in 11 cases (64.7%). Complete resection wasachieved in 14 patients (82.3%). Thirty-day mortality was 5.8% (n = 1). Major complicationsoccurred in 4 patients (23.5%): 3 bronchopleural fistulas (17.6%), 2ARDS (11.7%), and 1 cardiac hernia (5.8%). Nodal downstaging was diagnosed in 9(53%) patients (all passed from N2 to N1). Median survival was 12 months (range,1 to 90 months). Overall 5-year survival rate was 34%. Overall, 5-year freedomfrom recurrence was 58.2%. Seven patients (41%) had recurrence: 1 local (5.8%)and 6 systemic (35.2%). Patients receiving postoperative radiotherapy (n = 8) andthose with downstaging had a significant 5-year survival rate (50.6% vs 0%;logrank, p = .007, and 63.5% vs 0%; log-rank, p = .04). Patients with squamous cellcarcinoma (n = 9) had a best prognosis in respect of those with adenocarcinoma (n= 8) (76.2% vs 0%; logrank, p = .002). At multivariate analysis, postoperativeradiotherapy influenced long-term survival (p = .04).CONCLUSION: Induction chemotherapy improves patient selection avoidinguseless operation allowing a safety TSP with acceptable morbidity and mortality.In or experience, downstaging and squamous cell carcinoma are associated to abest prognosis. Postoperative radiotherapy improves long-term survival.5:15 p.m. ADJOURN107
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AATS FUTURE MEETINGSMay 1-5, 2010Me
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