title: Safe resection of the aortic wall infiltrated by lung cancer after placement of an endoluminal prosthesis.
abstract: BACKGROUND
  Few investigators have reported the results of combined resection of lung cancer infiltrating the thoracic aorta; only anecdotal accounts of off-label use of thoracic aortic endografts to facilitate resection of such tumors have been published. In this paper, we describe our experience using this innovative approach in terms of technical details and outcomes.
  
  
  METHODS
  We retrospectively reviewed data on 9 patients (6 men and 3 women, median age 61 years) with preoperatively suspected thoracic aorta neoplastic invasion, who were operated on after positioning of an endograft and underwent en bloc tumor resection including the aortic wall.
  
  
  RESULTS
  All but one cancer were non-small cell lung carcinomas; 4 patients received neoadjuvant chemotherapy, and 7 received adjuvant therapy. Aortic endografting was performed 2 to 17 days before resection of the tumor in 7 patients and as part of a one-stage procedure in 2 patients. The proximal end of the stent graft was deployed in the aortic arch (n = 1) or the descending aorta (n = 8). Lung resections were left pneumonectomies in 4 patients and left lower lobectomies in 5. Five patients underwent additional buttressing of the aortic defect using a synthetic patch (n = 2) or the omentum (n = 3). No cardiopulmonary bypass was required. At the last follow-up, 3 patients had evidence of tumor recurrence (one local and two distant). No endograft-related complications were detected.
  
  
  CONCLUSIONS
  Thoracic aortic endografting allowed safe en bloc resection of tumors invading the aortic wall, avoiding the need for extracorporeal circulatory support. Such an extended indication for thoracic aortic endografts seems promising and should be considered for selected oncologic cases.
authors.affiliation: Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy. Electronic address: beppemarulli@libero.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Marulli
authors.affiliation: Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Rea
authors.affiliation: Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Zampieri
authors.affiliation: Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Antonello
authors.affiliation: Division of Thoracic Surgery, University "Sapienza"-Sant'Andrea Hospital, Rome, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Maurizi
authors.affiliation: Division of Thoracic Surgery, University "Sapienza," Policlinico Umberto I, Rome, Italy; Lorillard-Spencer-Cenci Foundation, Rome, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Venuta
authors.affiliation: Division of Thoracic Surgery, University "Sapienza"-Sant'Andrea Hospital, Rome, Italy.
authors.forename: Camilla
authors.initials: C
authors.lastname: Poggi
authors.affiliation: Division of Thoracic Surgery, University "Sapienza"-Sant'Andrea Hospital, Rome, Italy; Lorillard-Spencer-Cenci Foundation, Rome, Italy.
authors.forename: Erino Angelo
authors.initials: EA
authors.lastname: Rendina
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic / Q000473:pathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D002277:Carcinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011013:Pneumonectomy; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome