208 * PNEUMONECTOMY WITH CARDIOPULMONARY BYPASS FOR LEFT LUNG CANCER EXTENDING TO THE PULMONARY ARTERY: TECHNIQUES AND RESULTS

Abstract

Objectives: We present our experience of pneumonectomy with cardiopulmonary bypass (CPB) for lung cancer invading the proximal left pulmonary artery (PA). Methods: Between 2005 and 2012, five men (mean age 51 [38-60] years) with a squamous cell carcinoma of the lung extending to the proximal left PA underwent a pneumonectomy with CPB. The patients were documented with computed tomography scan, magnetic resonance imaging scan, and cardiopulmonary tests. One patient was operated on through a lateral thoracotomy, with CPB via the main PA and the descending aorta, to perform a pneumonectomy with direct closure of the proximal left PA. In four cases, a median sternotomy was used with CPB via the ascending aorta and bicaval cannulation. After pneumonectomy extended to the initial left PA, angioplasty was performed with a patch (2 polytetrafluoroethylene and 2 pericardium). Results: There was no mortality. One patient with a residual PA stenosis required reoperation for widening the PA trunk with iterative angioplasty. Acute respiratory distress syndrome occurred in one patient requiring postoperative awake extracorporeal membrane oxygenation. pTNM staging was pT4N1 in two cases and pT4N2 in three cases. Adjuvant chemotherapy was given to four patients. During follow-up, two patients died, one from brain metastasis at 12 months and one from lymphoma at 25 months. Three patients are alive at 14, 22 and 66 months of follow-up, respectively. Conclusions: In selected patients with left lung cancer extending to the proximal left PA, a pneumonectomy can be safely performed with CPB through a median sternotomy. PA angioplasty must be large enough to avoid a stenosis of the PA trunk.