title: Ex situ reimplantation technique, in central lung tumors.
abstract: BACKGROUND
  The parenchyma-sparing resection is most often performed in patients with impaired preoperative lung or cardiovascular function who would not be able to tolerate a pneumonectomy.
  
  
  METHODS
  Our experience on the ex situ reimplantation procedure and the outcome of patients with lung malignancies, who underwent upper or upper-middle lobectomy, with reimplantation of the lower lobe was reported.
  
  
  RESULTS
  We present 9 patients mean age 62.6+16.2 years (7 males/2 females) underwent ex situ reimplantation due to extensive lung tumor of upper lobes. The surgical technique precludes IV heparinization and then radical pneumonectomy. The entire lung was immersed in Ringer's solution (temperature 4 degrees centigrade) and bench surgery was performed. The involved upper (or upper-middle) lobes with involved lymph nodes were resected, thus leaving the healthy lower lobe of the lung. Pneumoplegia solution, named "Papworth pneumoplegia", was administered (1,473 mL) through catheterization of the pulmonary artery and vein stumps (ante grade and retrograde) along with 250 mL of prostaglandin E1. Re-implantation of the lower lobe was performed (I) on the right side, implantation involved the anastomosis of lower pulmonary vein in the site of the cuff of left atrium, followed by suturing the stump of the intermedius pulmonary artery to the right main pulmonary artery and finally the bronchial stumps-intermedius bronchus to the right main bronchus; (II) on the left side the pulmonary vein was anastomosed first, followed by the bronchial stumps and finally by the pulmonary artery. The graft ischemia time was 70.2+8.4 minutes ranged between 55 and 80 minutes.
  
  
  CONCLUSIONS
  Re-implantation or auto-transplantation should be considered as a safe option for the appropriate patient with lung cancer. The ex situ separation of the cancerous lobes is technically feasible and allows extensive pulmonary resection while minimizing the loss of pulmonary reserve. Based on our work, the major factors that play a role for the survival of initially resected and then re-implanted lung graft, are: (I) the ischemia time of the re-implanted lobe; (II) the proper use of pneumoplegia solutions, along with prostaglandin E1 and heparin; (III) the occurrence of pulmonary vein thrombosis; and (IV) the bronchial anastomosis.
authors.affiliation: 1 Pulmonary Clinic, General Hospital "G. Papanikolaou", Thessaloniki, Greece ; 2 Pulmonary Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Greece ; 3 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Interbalkan European Medical Center Oncology Department, Thessaloniki, Greece ; 5 Interbalkan European Medical Center Pulmonary Department, Thessaloniki, Greece ; 6 Interbalkan European Medical Center Cardiothoracic Department, Thessaloniki, Greece.
authors.forename: Stavros
authors.initials: S
authors.lastname: Tryfon
authors.affiliation: 1 Pulmonary Clinic, General Hospital "G. Papanikolaou", Thessaloniki, Greece ; 2 Pulmonary Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Greece ; 3 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Interbalkan European Medical Center Oncology Department, Thessaloniki, Greece ; 5 Interbalkan European Medical Center Pulmonary Department, Thessaloniki, Greece ; 6 Interbalkan European Medical Center Cardiothoracic Department, Thessaloniki, Greece.
authors.forename: Paul
authors.initials: P
authors.lastname: Zarogoulidis
authors.affiliation: 1 Pulmonary Clinic, General Hospital "G. Papanikolaou", Thessaloniki, Greece ; 2 Pulmonary Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Greece ; 3 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Interbalkan European Medical Center Oncology Department, Thessaloniki, Greece ; 5 Interbalkan European Medical Center Pulmonary Department, Thessaloniki, Greece ; 6 Interbalkan European Medical Center Cardiothoracic Department, Thessaloniki, Greece.
authors.forename: Drosos
authors.initials: D
authors.lastname: Tsavlis
authors.affiliation: 1 Pulmonary Clinic, General Hospital "G. Papanikolaou", Thessaloniki, Greece ; 2 Pulmonary Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Greece ; 3 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Interbalkan European Medical Center Oncology Department, Thessaloniki, Greece ; 5 Interbalkan European Medical Center Pulmonary Department, Thessaloniki, Greece ; 6 Interbalkan European Medical Center Cardiothoracic Department, Thessaloniki, Greece.
authors.forename: Katerina
authors.initials: K
authors.lastname: Tsirgogianni
authors.affiliation: 1 Pulmonary Clinic, General Hospital "G. Papanikolaou", Thessaloniki, Greece ; 2 Pulmonary Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Greece ; 3 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Interbalkan European Medical Center Oncology Department, Thessaloniki, Greece ; 5 Interbalkan European Medical Center Pulmonary Department, Thessaloniki, Greece ; 6 Interbalkan European Medical Center Cardiothoracic Department, Thessaloniki, Greece.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Zissimopoulos
authors.affiliation: 1 Pulmonary Clinic, General Hospital "G. Papanikolaou", Thessaloniki, Greece ; 2 Pulmonary Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Greece ; 3 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Interbalkan European Medical Center Oncology Department, Thessaloniki, Greece ; 5 Interbalkan European Medical Center Pulmonary Department, Thessaloniki, Greece ; 6 Interbalkan European Medical Center Cardiothoracic Department, Thessaloniki, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Kioumis
authors.affiliation: 1 Pulmonary Clinic, General Hospital "G. Papanikolaou", Thessaloniki, Greece ; 2 Pulmonary Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Greece ; 3 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Interbalkan European Medical Center Oncology Department, Thessaloniki, Greece ; 5 Interbalkan European Medical Center Pulmonary Department, Thessaloniki, Greece ; 6 Interbalkan European Medical Center Cardiothoracic Department, Thessaloniki, Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Emmanouilides
authors.affiliation: 1 Pulmonary Clinic, General Hospital "G. Papanikolaou", Thessaloniki, Greece ; 2 Pulmonary Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Greece ; 3 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Interbalkan European Medical Center Oncology Department, Thessaloniki, Greece ; 5 Interbalkan European Medical Center Pulmonary Department, Thessaloniki, Greece ; 6 Interbalkan European Medical Center Cardiothoracic Department, Thessaloniki, Greece.
authors.forename: Sofia
authors.initials: S
authors.lastname: Baka
authors.affiliation: 1 Pulmonary Clinic, General Hospital "G. Papanikolaou", Thessaloniki, Greece ; 2 Pulmonary Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Greece ; 3 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Interbalkan European Medical Center Oncology Department, Thessaloniki, Greece ; 5 Interbalkan European Medical Center Pulmonary Department, Thessaloniki, Greece ; 6 Interbalkan European Medical Center Cardiothoracic Department, Thessaloniki, Greece.
authors.forename: Hercules
authors.initials: H
authors.lastname: Titopoulos
authors.affiliation: 1 Pulmonary Clinic, General Hospital "G. Papanikolaou", Thessaloniki, Greece ; 2 Pulmonary Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Greece ; 3 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Interbalkan European Medical Center Oncology Department, Thessaloniki, Greece ; 5 Interbalkan European Medical Center Pulmonary Department, Thessaloniki, Greece ; 6 Interbalkan European Medical Center Cardiothoracic Department, Thessaloniki, Greece.
authors.forename: Albert
authors.initials: A
authors.lastname: Dager
authors.affiliation: 1 Pulmonary Clinic, General Hospital "G. Papanikolaou", Thessaloniki, Greece ; 2 Pulmonary Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Greece ; 3 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Interbalkan European Medical Center Oncology Department, Thessaloniki, Greece ; 5 Interbalkan European Medical Center Pulmonary Department, Thessaloniki, Greece ; 6 Interbalkan European Medical Center Cardiothoracic Department, Thessaloniki, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Filippou
keywords: Non-small lung cancer; auto-transplantation; bench surgery; ex situ; re-implantation