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J Thorac Cardiovasc Surg 2005;129:804-808
© 2005 The American Association for Thoracic Surgery

General Thoracic Surgery

Surgical resection for lung cancer with infiltration of the thoracic aorta

^a Department of General Thoracic Surgery, Osaka University, Graduate School of Medicine, Osaka, Japan
^b Department of General Thoracic Surgery, Toneyama National Hospital, Osaka, Japan
^c Department of Cardiothoracic Surgery, Dokkyo University School of Medicine, Tochigi, Japan

Received for publication January 27, 2004; revisions received May 17, 2004; accepted for publication May 24, 2004.

^_* Address for reprints: Mitsunori Ohta, MD, Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, E1, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan (E-mail: ohta{at}surg1.med.osaka-u.ac.jp).

OBJECTIVE: The purpose of this study was to evaluate the results of a combined resection of the thoracic aorta and primary lung cancer.

METHODS: Sixteen patients underwent thoracic aorta resection along with a left pneumonectomy (n = 6), left upper lobectomy (n = 9), or partial lung resection (n = 1), of whom 10 also received preoperative induction therapy. Cardiopulmonary bypass was used in 10 patients, and a passive shunt between the ascending aorta and the descending aorta was used in 4 patients.

RESULTS: Six postoperative major complications occurred in 5 patients, including postoperative bleeding (n = 3), intraoperative bleeding (n = 1), chylothorax (n = 1), and respiratory failure (n = 1). The postoperative morbidity rate was 31%, and the mortality rate was 12.5% (2/16). Furthermore, 4 patients died of systemic tumor relapse, and 1 patient died of intrapleural recurrence. Nine patients were alive after a median follow-up of 54 months (range, 12–199 months). The median survival time of patients with postoperative pathologic N0 disease was 31 months, whereas it was 10 months for those with pathologic N2 or N3 disease. Five-year survivals were 70% for patients with N0 disease and 16.7% for patients with N2 or N3 disease (P = .0070).

CONCLUSIONS: Although pulmonary resection with the involved aorta might cause high surgical morbidity and mortality rates, encouraging long-term survivals were obtained in patients without mediastinal nodal involvement.

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