J Thorac Cardiovasc Surg 2001;121:0077-0082
© 2001 The American Association for Thoracic Surgery
Surgical treatment of pulmonary artery sarcoma
Eckhard Mayer, MDa,
Jörg Kriegsmann, MDb,
Andreas Gaumann, MDb,
Hans Ulrich Kauczor, MDc,
Manfred Dahm, MDa,
Ulrich Hake, MDa,
Franz Xaver Schmid, MDa,
Hellmut Oelert, MDa
From the Departments for Cardiothoracic and Vascular Surgery,a Pathology,b and Radiology,c Johannes Gutenberg-University, Mainz, Germany.
Received for publication June 6, 2000. Revisions requested Aug 1, 2000; revisions received Aug 28, 2000. Accepted for publication Aug 31, 2000.
Address for reprints: Eckhard Mayer, MD, Department for Cardiothoracic and Vascular Surgery, Johannes Gutenberg University Hospital, Langenbeckstr 1, 55101 Mainz, Germany (E-mail: emayer{at}mail.uni-mainz.de).
Objective: Pulmonary artery sarcomas are rare and usually fatal tumors. The diagnosis is difficult and delayed in most cases. Newer imaging techniques could allow early diagnosis in patients with symptoms of pulmonary vascular obstruction. Surgical resection improves clinical symptoms and offers the only chance of cure. We report the case histories of 7 patients with primary pulmonary artery sarcomas treated by surgical resection with or without adjuvant therapy.
Methods: Seven patients (3 women and 4 men; mean age, 52.3 years; preoperative New York Heart Association functional class III/IV, n = 5/2) underwent operations. Malignancy was preoperatively suspected in 5 patients, and 2 patients had a presumptive diagnosis of chronic pulmonary embolism. Tumor resection with partial or total prosthetic replacement (n = 2), reconstruction (n = 5), or both, of central parts of the pulmonary arteries was performed in 6 patients. Thromboendarterectomy was necessary in 4 patients, and pneumonectomy was necessary in 2 patients. Six patients received adjuvant therapy.
Results: There was no perioperative mortality. All patients had a substantial improvement in exercise tolerance and hemodynamics 3 months after their operations. Four patients died 7, 9, 18, and 19 months after their operations because of recurrent tumor or pulmonary metastases. Two patients are alive 21 and 35 months after primary surgical repair, with pulmonary metastases detected by computed tomographic scans. One patient is alive 62 months after resection without clinical or radiologic signs of tumor recurrence or metastasis.
Conclusions: Early diagnosis of primary pulmonary artery sarcomas can be improved by computed tomography and magnetic resonance scanning. Radical surgical resection probably presents the only chance for cure. The role of neoadjuvant or adjuvant treatment modalities has to be defined. Pulmonary artery sarcoma need not necessarily be a fatal diagnosis.
Copyright © 2001 by The American Association for Thoracic Surgery.
