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J Thorac Cardiovasc Surg 2009;137:1400-1405
© 2009 The American Association for Thoracic Surgery

General Thoracic Surgery

Lobectomy with pulmonary artery resection: Morbidity, mortality, and long-term survival

^a Department of Thoracic Surgery, Hôtel Dieu Hospital, AP-HP, Paris, France
^b Department of Pneumology, Hôtel Dieu Hospital, AP-HP, Paris, France
^c Department of Pneumology, St Antoine Hospital, AP-HP, Paris, France

Received for publication April 30, 2008; revisions received September 11, 2008; accepted for publication November 2, 2008.

^_* Address for reprints: Marco Alifano, MD, Unité de Chirurgie Thoracique, Hôtel Dieu, 1, Place du Parvis Notre-Dame, 75181 Paris Cedex, France . (Email: marcoalifano{at}yahoo.com).

Objective: We report our experience with 93 consecutive pulmonary artery reconstructions during pulmonary lobectomy with regard to morbidity, mortality, and long-term survival.

Methods: Clinical records of all patients who underwent lobectomy with partial or circumferential pulmonary artery resection in a single institution during an 8-year period were reviewed retrospectively.

Results: Lobectomy with partial (n = 90) or circumferential (n = 3) pulmonary artery resection was carried out in 93 patients. Indications for surgical intervention were non–small cell lung cancer in 87 patients and other malignancy in the remaining 6 patients. Bronchial sleeve resection was associated in 23 patients. Neoadjuvant chemotherapy had been administered in 34 cases because of cN2 disease. Operative mortality was 5.4%. Postoperative complications occurred in 27 (29.0%) patients. All the patients underwent contrast-enhanced computed tomographic scanning 6 to 8 weeks postoperatively, which always showed patency of the pulmonary arteries. In the whole population median and 5-year survivals were 40 months and 39.4%, respectively. Disease-free survival was 41.4% at 5 years. Among patients with non–small cell lung cancer, at univariate analysis, tumor size of less than 3 cm; presence of vascular peritumoral emboli, intratumoral emboli, or both; and dyspnea influenced 5-year survival. Multivariate analysis showed that the size of the primary tumor and the presence of vascular emboli were independent factors of worse outcome.

Conclusions: Lobectomy with arterial sleeve resection has acceptable mortality and no specific complications. Late results in terms of survival are satisfactory.