211251 Reconstruction of pulmonary artery by autologous pericardium or azygous venae for non-small cell lung cancer

/Liu Xuegang(刘学刚，Dept Cardiothorac Surg，Affil Hosp Bengbu Med Col，Bengbu 233004)…∥Chin J Thorac Cardiovasc Surg.-2011，27(1).-20 ～23

ObjectiveTo review the clinical experience of reconstruction of pulmonary artery(PA)by a patch of autologus pericardium or azygous venae for non-small cell lung cancer.MethodsBetween March 1992 and August 2009，62 patients with locally advanced central lung cancer received sleeve resection and reconstruction of PA.Ac-cording to PTNM classification，4 patients were in stageⅡb，46 in stageⅢa and 12 in stageⅢb.17 patients had induction chemothoerapy.Sleeve lobectomy or bilobectomy were performed in 51patients and standard lobectomy in 11.Depending on the degree of tumour infiltrating the PA，the surgical procedures included partial PA tangential resections and reconstructions by a patch of autologous azygous venae in 18 cases，a patch of autologous pericardium in 38 cases and a complete PA sleeve resection reconstruction by a custom-made autologous pericardial conduit interposition in 6 cases.Partial superior vena cava tangential resections and reconstructions were performed in 5 patients by a patch of autologous pericardium or azygous venae.47 patients received postoperative chemotherapy and 19 had radiotherapy.ResultsThere was 2 early postoperative deaths(3.2%).The cause of death was bronchial anastomotic leak led to respiratory failure in 1 case and severe arrhythmia led to heart arrest in 1.No cancerous tissue of all resection margins are checked by frozen section histology and examination of resection specimens in the surgical pathology laboratory.The postoperative complications occurred in 11 patients(17.7%)and all of them recovered uneventfully.Roentgenography，flexible bronchoscopy and echocardiography were in normal range in the remaining 60 patients with no bronchial anastomosis stenosis or vascular thombosis before discharge and at 2-6months after surgery.The mean follow up time was 49.5months(6-210 months).The overall 1，3，5 and 10 year survival rates were 80.2%，44.7%，31.4%and 23.1%，respectively.ConclusionReonstruction of PA by autologous pericardial patch or autologous azygous vein patch is a safe and effective technique for locally advanced lung cancer.For extended circumferential defects of PA，the autologous pericardial conduit interposition could be used for reconstruction.15 refs.