Surgical resection for lung cancer with infiltration of the thoracic aorta.
OBJECTIVE
The purpose of this study was to evaluate the results of a combined resection of the thoracic aorta and primary lung cancer.


METHODS
Sixteen patients underwent thoracic aorta resection along with a left pneumonectomy (n = 6), left upper lobectomy (n = 9), or partial lung resection (n = 1), of whom 10 also received preoperative induction therapy. Cardiopulmonary bypass was used in 10 patients, and a passive shunt between the ascending aorta and the descending aorta was used in 4 patients.


RESULTS
Six postoperative major complications occurred in 5 patients, including postoperative bleeding (n = 3), intraoperative bleeding (n = 1), chylothorax (n = 1), and respiratory failure (n = 1). The postoperative morbidity rate was 31%, and the mortality rate was 12.5% (2/16). Furthermore, 4 patients died of systemic tumor relapse, and 1 patient died of intrapleural recurrence. Nine patients were alive after a median follow-up of 54 months (range, 12-199 months). The median survival time of patients with postoperative pathologic N0 disease was 31 months, whereas it was 10 months for those with pathologic N2 or N3 disease. Five-year survivals were 70% for patients with N0 disease and 16.7% for patients with N2 or N3 disease ( P = .0070).


CONCLUSIONS
Although pulmonary resection with the involved aorta might cause high surgical morbidity and mortality rates, encouraging long-term survivals were obtained in patients without mediastinal nodal involvement.
Ohta
Mitsunori
M
Department of General Thoracic Surgery, Osaka University, Graduate School of Medicine, Osaka, Japan. ohta@surg1.med.osaka-u.ac.jp
Hirabayasi
Hirohisa
H
Shiono
Hiroyuki
H
Minami
Masato
M
Maeda
Hajime
H
Takano
Hiroshi
H
Miyoshi
Shinichiro
S
Matsuda
Hikaru
H
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D001013:Aorta, Thoracic / Q000473:pathology / Q000601:surgery*; D001018:Aortic Diseases / Q000473:pathology / Q000601:surgery*; D016063:Blood Loss, Surgical; D018287:Carcinoma, Large Cell / Q000473:pathology / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery; D002315:Cardiopulmonary Bypass; D002423:Cause of Death; D002916:Chylothorax / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D011013:Pneumonectomy; D011183:Postoperative Complications; D019106:Postoperative Hemorrhage / Q000209:etiology; D012131:Respiratory Insufficiency / Q000209:etiology; D015996:Survival Rate; D019043:Vascular Neoplasms / Q000473:pathology / Q000601:surgery*