Sleeve resection and prosthetic reconstruction of the pulmonary artery for lung cancer

Rendina, Erino Angelo; Venuta, Federico; Giacomo, Tiziano De; Ciccone, Anna Maria; Moretti, M.; Ruvolo, Giovanni; Coloni, Giorgio F.

doi:10.1016/s0003-4975(99)00738-9

Cited by 109 publications

(88 citation statements)

References 16 publications

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“…PA reconstruction techniques range from direct oversewing, which is appropriate in cases of limited tangential resection, and pericardial patch closure, which is used when more than one third of the arterial circumference has to be resected, to end-to-end anastomosis (sleeve resection), which is used when the defect affects >50% of the arterial wall. [1][2][3] Interposition of a conduit could be required when the extent of the circumferential PA defect PA Reconstruction with a Prosthetic Conduit pulmonary veins 5,6) serving as possible alternatives. PA sleeve resection and reconstruction with autologous pericardium is thought to be a safe procedure.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Artery Reconstruction with a Prosthetic Conduit in Lung Cancer

Yoshida

Toishi

Agatsuma

et al. 2014

ATCS

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In radical pulmonary resection for advanced lung cancer, reconstruction of the pulmonary artery (PA) can preserve the lung parenchyma. Reconstruction techniques have gained acceptance because they enable the surgeon to avoid pneumonectomy. Various techniques have been documented, such as direct suturing, end-to-end anastomosis, and a patch or conduit reconstruction. We present two lobectomy cases in which the patients underwent PA reconstruction with prosthetic conduits because they were unfit for other procedures. In both cases, the conduits showed good postoperative patency. When interposition of a conduit is required for PA reconstruction, the use of a prosthetic conduit should be considered in selected cases.

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Section: Discussionmentioning

confidence: 99%

Pulmonary Artery Reconstruction with a Prosthetic Conduit in Lung Cancer

Yoshida

Toishi

Agatsuma

et al. 2014

ATCS

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“…Conduit options include autologous pericardium, pulmonary vein, or PTFE. In the presence of concomitant airway injuries, use of interposition muscle flaps may be considered to prevent bronchoarterial fistulas (43)(44)(45)(46)(47). Complex repair of the pulmonary vein is most commonly associated with stapling of a common trunk of the left pulmonary vein.…”

Section: Surgical Prevention and Management Techniquesmentioning

confidence: 99%

Prevention and management of intraoperative crisis in VATS and open chest surgery: how to avoid emergency conversion

Safdie¹,

Sanchez²,

Sarkaria³

2017

J. Vis. Surg.

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Video assisted thoracic surgery (VATS) has become a routinely utilized approach to complex procedures of the chest, such as pulmonary resection. It has been associated with decreased postoperative pain, shorter length of stay and lower incidence of complications such as pneumonia. Limitations to this modality may include limited exposure, lack of tactile feedback, and a two-dimensional view of the surgical field. Furthermore, the lack of an open incision may incur technical challenges in preventing and controlling operative misadventures leading to major hemorrhage or other intraoperative emergencies. While these events may occur in the best of circumstances, prevention strategies are the primary means of avoiding these injuries. Unplanned conversions for major intraoperative bleeding or airway injury during general thoracic surgical procedures are relatively rare and often can be avoided with careful preoperative planning, review of relevant imaging, and meticulous surgical technique. When these events occur, a pre-planned, methodical response with initial control of bleeding, assessment of injury, and appropriate repair and/ or salvage procedures are necessary to maximize outcomes. The surgeon should be well versed in injuryspecific incisions and approaches to maximize adequate exposure and when feasible, allow completion of the index operation. Decisions to continue with a minimally invasive approach should consider the comfort and experience level of the surgeon with these techniques, and the relative benefit gained against the risk incurred to the patient. These algorithms may be expected to shift in the future with increasing sophistication and capabilities of minimally invasive technologies and approaches. hemorrhage within moments. While these events may occur in the best of circumstances, prevention strategies are the primary means of avoiding these injuries. When they do occur, premeditated and expedited intervention is the key to rescue (1). The current report focuses on the prevention and management of these emergency bleeding events in VATS pulmonary resections. Preoperative radiologic assessment of vascular and anatomic variationRigorous preoperative evaluation of fitness of surgery is a key component of any operative assessment. Preoperative identification and awareness of case-specific and patientspecific risk factors may help prevent hemorrhagic complications in most lung resections. These factors include body habitus, preoperative chemotherapy and radiation, bleeding diatheses including medical anticoagulants, previous thoracic surgery, lymph node calcification and/or granulomatous disease, tumor size and location.Computed chest tomography has become a standard of care in virtually all cases considered for major pulmonary resection. These high resolution scans, often available with three dimensional reconstruction, can provide valuable opportunities to identify standard and anomalous vascular variations prior to surgery in greater than 95% of cases (2-6). Imaging may also identify cal...

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“…In 1999, RENDINA et al [77] described 52 patients who had undergone a variety of pulmonary artery reconstructions for lung cancer. There were no operative deaths and 5-yr survival rates were 38.3% for the entire group, 18.6% for stages III-a/III-b, and 64.4% for stages I and II.…”

Section: T3: Proximal Airway Tumoursmentioning

confidence: 99%

Current surgical treatment of nonsmall cell lung cancer 2001

Deslauriers¹

2002

European Respiratory Journal

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Recognizing that surgical treatment is still the best option for controlling lung cancer, surgeons want an operation to be performed when the benefits clearly outweigh the possible risks, and when it has been determined that cancer resection is the most appropriate course of management. The necessity for a compulsive attitude toward preoperative assessment is therefore to be emphasized.Approximately 45% of all lung cancers are limited to the chest, where surgical resection is the most effective method of controlling the disease. Patients with tumour (T) 1, node (N) 0 and T2N0 tumours have early lung cancer, and most are curable by resection, with 5-yr survival rates in the range 75-80% for patients with T1N0 status. The "gold standard" of surgery remains lobectomy. Stage T1N1 and T2N1 carcinomas represent a group of patients in whom the disease involves hilar and bronchopulmonary nodes. This group is best treated by complete resection and mediastinal lymphadenectomy.Survival data following surgical resection of T3 tumours clearly show better survival in patients with T3N0 disease than in those with T3N1-2 disease. Five-year survival rates for completely resected T3N0 lesions are in the range 30-50%. Once N1 disease is present, survival decreases to 15-20%. Incomplete resections fail to cure and surgery is not indicated if N2 disease is documented preoperatively. On occasion, T4 tumours involving the carina or vertebral body can be completely resected but T4N1-2 lesions are virtually incurable by surgery.The presence of mediastinal lymph node metastasis (N2/N3 disease) is an ominous prognostic sign and stage III-b disease, by virtue of metastatic contralateral nodes, is an absolute contraindication to surgical resection. Induction treatments with chemoradiation have shown prolongation of survival and three randomized trials have demonstrated a survival advantage over surgery alone.

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Sleeve resection and prosthetic reconstruction of the pulmonary artery for lung cancer

Cited by 109 publications

References 16 publications

Pulmonary Artery Reconstruction with a Prosthetic Conduit in Lung Cancer

Pulmonary Artery Reconstruction with a Prosthetic Conduit in Lung Cancer

Prevention and management of intraoperative crisis in VATS and open chest surgery: how to avoid emergency conversion

Current surgical treatment of nonsmall cell lung cancer 2001

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