Resection of thoracic malignancies infiltrating cardiac structures with use of cardiopulmonary bypass

Abstract

BackgroundOnly few reports exist on malignant thoracic neoplasms that require cardiopulmonary bypass during resection. We aimed to investigate the early and late clinical outcome of these patients.MethodsPatients with thoracic malignancies that underwent surgery between 2002 and 2014 were analyzed. All patients had cardiopulomonary bypass support during resection. Clinical and perioperative data was retrospectively reviewed for outcome and overall survival.ResultsFifteen patients (12 female, mean age of 55 ± 15 years, range 24 to 80 years) were identified. Eleven (8 female) were diagnosed with primary thoracic malignomas and four with metastases. Three patients died early postoperatively. Patients diagnosed with sarcoma had a significantly worse outcome than non-sarcoma patients (83.3 ± 15.2 % after 1 year, 31.3 ± 24.5 % after 5 years vs. 83.3 ± 15.2 % after 1 year, 0 ± 0 % after 5 years, p = 0.005).ConclusionsMalignancies with extension into cardiac structures or infiltration of great vessels can be resected with cardiopulmonary bypass support and tolerable risk. Carefully selected patients can undergo advanced operative procedures with an acceptable 1-year-survival, but only few patients achieved good long-term outcome.

Cardiopulmonary bypass in thoracic surgery

“…Осложнения развиваются у 14-54% пациентов [2,7,22,26,31,32,38]. От 37 до 50% пациентов переносили послеоперационную пневмонию или острое повреждение легкого, вызванное, по мнению ряда авторов, ИК [9,15,17,32]. Другим грозным осложнением является послеоперационное кровотечение, которое может требовать выполнения повторной хирургической операции в 15-50% наблюдений [22,33,38].…”

Cardiac metastasectomy with cardiopulmonary bypass in a case of mediastinal osteosarcoma metastasis with left atrial invasion

“…[5][6][7] However, if cardiac structures are infiltrated, curative resection remains challenging and CPB support is often required. Moreover, CPB implies several additional risks including excessive bleeding due to systemic heparinization, possibility of intraoperative tumor spilling, and immune modulatory effects of extracorporeal circulation.…”

“…Moreover, CPB implies several additional risks including excessive bleeding due to systemic heparinization, possibility of intraoperative tumor spilling, and immune modulatory effects of extracorporeal circulation. [7,8] Considered to be the best available therapeutic option for our patient, another metastasectomy was performed under CPB and cardiac arrest with partial left atrial resection and reconstruction.…”

Infiltration der herznahen Gefäße durch Lungenkarzinome: Inzidenz, Klassifikationen, operative Technik unter Einsatz der Herz-Lungen-Maschine und Ergebnisse

“…Entsprechend der verbreiteten Befürchtung, durch einen Cell Saver Tumorzellen zu disseminieren, wird dieser bei Tumoroperationen im eigenen Haus nicht eingesetzt. In einer Arbeit von Arif et al [11] wird über 15 Patienten berichtet, die sich einer thorakalen Karzinomresektion unter Einsatz der Herz-Lungen-Maschine unterzogen. Bei 4 Patienten kam ein Cell Saver zum Einsatz.…”

“…Bei 4 Patienten kam ein Cell Saver zum Einsatz. Arif et al [11] berichteten auch über ihre Sorge einer Streuung von Tumorzellen. Sie regten an, während des Einsatzes der Herz-Lungen-Maschine darauf zu verzichten, Saugerblut aus dem Thorax über den Kardiotomiesauger wieder dem Kreislauf zuzuführen.…”