Factors affecting survival after lobectomy with pulmonary artery resection for primary lung cancer

Objective: Prognostic factors in patients who underwent pulmonary angioplasty remain controversial. Here, we report a case-series study of this surgical procedure based on our 20-year single-center experience.

Methods: Medical records of patients, who underwent a major lung cancer operation with pulmonary artery resection, were reviewed retrospectively.

Results: From 1986 to 2006, 61 (3%) of 2296 patients required pulmonary artery resection to avoid pneumonectomy for lung cancer surgery. We performed 34 circumferential resections and 27 wedge resections accompanied by lobectomy or bilobectomy, and all repairs were performed with end-to-end anastomoses or direct suturing. Patch reconstruction, synthetic/biological prosthesis, and pericardial conduit were not used. Forty-nine patients (80%) underwent concomitant carinoplasty (n = 2) or bronchoplasty (n = 47). After surgery, two patients died (mortality 3.3%) and major complications were noted in 14 patients (morbidity 23.0%). Although seven patients had local recurrences (four intrathoracic and three lymph nodes), no recurrence was observed along the pulmonary artery suture line. With a mean follow-up period of 46.0 ± 40.5 months, overall and disease-free survival rates for all cases were 47.0% and 40.0% at 5 years, and 40.2% and 33.6% at 10 years. According to the nodal status, the 5-years' overall and disease-free survivals were 76.0% and 62.9% for pN0 cases (n = 14), 45.7% and 43.5% for pN1 cases (n = 27), and 28.9% and 20.0% for pN2 + pN3 cases (n = 20), respectively (p = 0.014 and 0.036). Multivariate analysis indicated that nodal status was the only prognostic factor on both overall and disease-free survival.

Conclusions: A major anatomical lung operation with pulmonary artery resection is feasible for selected patients with primary lung cancer. Long-term outcomes are significantly influenced by nodal status and are comparable to those of conventional lobectomy. Most operative complications are controllable with acceptable mortality and morbidity rates. The anastomosed site was not placed at risk for local recurrence. These data support pulmonary angioplasty as a valuable option in the treatment of lung cancer.