Lobectomy with angioplasty: which is the best technique for pulmonary artery reconstruction?

Abstract

Lobectomies with bronchial and/or vascular reconstruction are conservative procedures aimed at managing locally advanced lung cancer, avoiding a pneumonectomy. Considering morbidity, mortality and the functional consequences of a pneumonectomy, such procedures must be in the technical armamentarium of every thoracic surgeon. Vascular reconstruction of the pulmonary artery (PA) is seldom performed with or without the bronchial sleeve resection. Both functional and oncologic outcomes have been reported to be better than after a pneumonectomy. Different technical options are now available but some aspects and technical details are not standardized. Indications, possible complications, planning and even definitions need to be more solid to allow for definitive improvement in such procedures. This analysis is aimed at assessing the acquired technical data with special emphasis on the PA reconstruction with autologous tissues.

Is pneumonectomy still necessary?

“…It is however acceptable to envision that one could perform an arterial resection followed by its reconstruction and observe convincing results. Different techniques are available for PA reconstruction depending mainly on the size of the defect and the surgeon's experience (21): direct reconstruction with tangential vascular reconstruction with direct suture, transverse suture, end-to-end anastomosis and/or graft reconstruction with different autologous tissues. Whilst the various technical possibilities to achieve this surgical procedure might be seen as acceptable options, one should not obfuscate the difficulty associated with this surgical procedure.…”

Preoperative Endobronchial Sanitation as Preparation for Thoracic Interventions

“…After completing the course of preoperative preparation using various methods of rehabilitation of the tracheobronchial tree, were noted significant changes in the inflammatory process in the bronchial tree, according to a number of clinical, laboratory, endoscopic and morphological criteria [12].…”

“…Moreover, they have big problems in treatment and the operation significantly worsen the quality of life of radically operated patients [9,10]. Conservative treatment of bronchial fistula can be successful only in the early stages of formation of the fistula, until the formation of a stable scar channel and his epithelization [11,12].…”

Short- and long-term results of angioplastic lobectomy in lung cancer surgery

“…Gundersen [11]. С этого времени операции при раке легкого с резекцией и реконструкцией легочной артерии полу чили значительное развитие [7,8,23].…”

“…Случаи по N статусу распределились сле дующим образом: рN0 -44 (47,8 %), рN1 -32 (34,8 %), рN2 -16 (17,4 %). При этом стадия Ia зафиксирована у 4 человек (4,3 %), Ib стадия -у 6 (6,5 %), IIa стадия -у 26 (28,3 %), IIb стадия -у 34 (37 %), IIIа стадия -у 22 (23,9). Показаниями к выполнению компромиссной ангиопластической лобэктомии стали ин фильтрация щелевой части легочной артерии первичной периферической опухолью, распо ложенной в корне оперируемой доли легкого (48 случаев, 52,2 %); инфильтрация легочной артерии лимфоузлами N1 (24 случая, 26 %); инфильтрация легочной артерии лимфоузлами N2 (12 случаев, 13,1 %), десмопластическая ре акция вокруг легочной артерии после неоадъю вантной химиотерапии (8 случаев, 8,7 %).…”