Survival After Extended Resection for Mediastinal Advanced Lung Cancer: Lessons Learned on 167 Consecutive Cases

Surgery for T4 lung cancer invading the thoracic aorta: Do we push the limits?

“…Looking at the more recent literature (Table ), less than 150 cases have been reported, with the greater series accounting for 28 patients. In these series the surgical mortality was reported to range between 0% and 12.5%, and major morbidities affected 7‐23% of patients . Our experience confirmed the low mortality rate (2.9%) with an overall morbidity rate reaching 37.1%.…”

“…In these series the surgical mortality was reported to range between 0% and 12.5%, and major morbidities affected 7-23% of patients. [1][2][3][4][5][6][7][8][9][10]15,16 Our experience confirmed the low mortality rate (2.9%) with an overall morbidity rate reaching 37.1%. The most common complication was bleeding (six cases), which occurred in two cases intraoperatively due to an aortic lesion during the attempt of subadventitial dissection, thus requiring Some surgeons prefer the use of a passive shunt between the ascending and descending aortas to avoid extracorporeal circulation 1,5 and to maintain perfusion in the lower part of the body.…”

“…The most common complication was bleeding (six cases), which occurred in two cases intraoperatively due to an aortic lesion during the attempt of subadventitial dissection, thus requiring emergency clamping in one case and the need for CPB in another. The surgical approach to vascular infiltration is still a debated issue and different types of aortic resection (tubular aortic resection/reconstruction, partial resection, and reconstruction with synthetic patches and subadventitial dissection) and intraoperative tools for cardiovascular support (CPB support, AA shunt, cross clamp, or aorta endografting) have been reported in the literature revealing a non‐homogeneous surgical management . Each technique has specific advantages and drawbacks however in our opinion, also specific indications; therefore, the choice of surgical approach and cardiovascular support should take into account several factors.…”

“…In selected cases, surgical resection may be considered as an upfront option or may follow the induction treatment; when a radical resection is accomplished, good long‐term oncologic results have been reported . Some investigators have described en bloc resection of lung cancer invading the aorta by using different techniques and intraoperative supports: temporary cardiopulmonary bypass (CPB), aorto‐aortic (AA) passive shunt, and direct clamping or thoracic aortic endograft have all been used to allow safe vascular management and resection, with encouraging results . Each approach has specific advantages and drawbacks: although on the one hand extracorporeal circulatory support reduces the risk of hemodynamic instability and increases the rate of radical resection compared with direct temporary vascular clamping, on the other hand such this support is associated with a potential increased risk of post‐operative complications including bleeding.…”

“…emergency clamping in one case and the need for CPB in another. The surgical approach to vascular infiltration is still a debated issue and different types of aortic resection (tubular aortic resection/reconstruction, partial resection, and reconstruction with synthetic patches and subadventitial dissection) and intraoperative tools for cardiovascular support (CPB support, AA shunt, cross clamp, or aorta endografting) have been reported in the literature revealing a nonhomogeneous surgical management [1][2][3][4][5][6][7][8][9][10]15,16. Each technique has specific advantages and drawbacks however in our opinion, also specific indications; therefore, the choice of surgical approach and cardiovascular support should take into account several factors.The use of extracorporeal circulation techniques (eg, temporary CPB) may be burdened by increased risk of bleeding, paraplegia, stroke, cardiac events, respiratory or renal failure, and potential systemic spread of tumor cells.…”