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Right arrow Lung - transplantation

J Thorac Cardiovasc Surg 2004;127:1343-1349
© 2004 The American Association for Thoracic Surgery

General thoracic surgery

Experimental study of extracorporeal lung resection in dogs: Ex situ sleeve resection and autotransplantation of the pulmonary lobe after extended pneumonectomy for central lung cancer

Isao Matsumoto, MDa,*, Makoto Oda, MDa, Yoshio Tsunezuka, MDa, Masaya Tamura, MDa, Kazuyuki Kawakami, MDa, Go Watanabe, MDa

a Department of General and Cardio-thoracic Surgery, Kanazawa University, Kanazawa, Japan

Received for publication July 25, 2003; revisions received October 14, 2003; accepted for publication December 2, 2003.

* Address for reprints: Isao Matsumoto, MD, Department of General and Cardio-thoracic Surgery, Kanazawa University, Takara-machi 13-1, Kanazawa 920-8641, Japan
mat{at}p2223.nsk.ne.jp

OBJECTIVE: Extracorporeal lung resection as an alternative to pneumonectomy for central lung cancer is a procedure in which the unilateral lung is extirpated, removing the pulmonary lobe with the cancers and replanting the residual pulmonary lobe. The aim of this study was to investigate whether extracorporeal lung resection for lung cancer can be performed safely.

METHODS: Nineteen dogs were divided into the control and extracorporeal lung resection groups. The former (n = 5) underwent lung autotransplantion, and the latter was subdivided into ND1 (n = 7) and ND2 (n = 7) groups on the basis of the manner of lymph node dissection. By comparing the 3 groups, the adverse effects of lymph node dissection were examined.

RESULTS: All dogs in the control group had no complications. Four dogs in the ND1 group survived for 90 to 630 days after the operation. In the ND2 group 5 dogs succumbed within 30 days after the operation, although the other 2 dogs survived for 391 and 573 days, respectively. Bronchopulmonary fistulas were seen in 1 of the ND1 dogs and 3 of the ND2 dogs. Two of the latter were free of thrombus formation in the pulmonary arteries and veins of the autografts. In the ND2 group, compared with the control and ND1 group, the tissue blood flow at the bronchial anastomotic site indicated reduction between the 3rd and 14th postoperative days.

CONCLUSION: The extensive lymph node dissection had severe adverse effects on bronchial anastomotic healing in extracorporeal lung resection. Therefore extracorporeal lung resection can be applied to only a very limited number of patients with N0 or N1 disease.






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