title: Triple plasty of bronchus, pulmonary artery, and superior vena cava for non-small cell lung cancer.
abstract: BACKGROUND
  It has been technically challenging to perform simultaneous triple plasty on the superior vena cava (SVC), pulmonary artery (PA), and main bronchus for central-type lung cancers. In the present study, the authors describe a corresponding technique and clinical outcomes of this surgical manipulation.
  
  
  METHODS
  Clinical data from 4 patients with non-small cell lung cancer (NSCLC) who underwent triple plastic resections and reconstructions were retrospectively reviewed. Three patients received neoadjuvant chemotherapy for pathologically proven locally advanced disease. For pulmonary arteries, sleeve resection with end-to-end anastomosis was performed in 2 patients; tangential resection was used in the other 2 patients. SVC resection with ringed polytetrafluoroethylene (PTFE) graft interposition was performed in 1 patient; the other 3 patients underwent tangential SVC resection. Sleeve resection of the bronchus was performed in all 4 patients. Systemic lymphadenectomy was accomplished in all patients.
  
  
  RESULTS
  There was histologic confirmation of large cell carcinoma, adenocarcinoma, squamous cancer, and adenosquamous cancer, respectively, in these 4 patients. Stage pT4N2M0-IIIB was confirmed in 2 patients, and stage T4N1M0-IIIA and stage T2aN2M0-IIIA were confirmed in the other 2 patients. There were no perioperative deaths. Postoperative atrial fibrillation and prolonged air leakage occurred in 2 patients, respectively. Four patients underwent postoperative chemotherapy and 2 patients were administered radiotherapy. Patients were followed for 21 to 38 months: Two patients had disease-free survival at their 32-month and 38-month follow-ups, and the other 2 patients died 21 and 22 months, respectively, after operation because of remote metastasis.
  
  
  CONCLUSIONS
  Triple plasty of bronchus, PA, and SVC is both practical and safe for patients with locally advanced NSCLC. For patients with strict indications, the long-term survival is favorable.
authors.affiliation: Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Yifeng
authors.initials: Y
authors.lastname: Sun
authors.forename: Hui
authors.initials: H
authors.lastname: Zheng
authors.forename: Qiankun
authors.initials: Q
authors.lastname: Chen
authors.forename: Minwei
authors.initials: M
authors.lastname: Bao
authors.forename: Gening
authors.initials: G
authors.lastname: Jiang
authors.forename: Chang
authors.initials: C
authors.lastname: Chen
authors.forename: Wen
authors.initials: W
authors.lastname: Gao
mesh_terms: D001980:Bronchi / Q000601:surgery*; D002289:Carcinoma, Non-Small-Cell Lung / Q000601:surgery*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods*; D011651:Pulmonary Artery / Q000601:surgery*; D012189:Retrospective Studies; D014683:Vena Cava, Superior / Q000601:surgery*