Abstract
Tubular resection of the aorta with vascular graft replacement was performed, under temporary bypass, in two patients with advanced lung cancer invading the thoracic aorta after neoadjuvant chemotherapy. Extended excision is discussed from the aspect of surgical technique, including shunting procedure during aortic clamping.
Case 1 : A 50-year-old male had squamous cell lung carcinoma with invasion of the trunk of the left pulmonary artery and descending aorta. Left pneumonectomy was combined with tubular excision of the descending aorta and reconstruction with a Dacron graft, during temporary bypass between the central and peripheral sides of the invasion site. Thoracotomy through the 5th intercostal space with an antero-axillary incision provided an adequate operative field. Histopathological examination showed infiltration to the adventitia of the aorta. The postoperative course was good, but the patient died from cerebral metastasis 13 months after surgery.
Case 2 : A 45-year-old male with squamous cell lung carcinoma was found to have marked invasion of the distal aortic arch at the time of thoracotomy at another hospital. Combined tubular excision of the aorta and left pneumonectomy were performed during left heart bypass with a Bio-pump an effective between the left atrium and the descending aorta. This was way to assure circulation. Although invasion of the aortic wall was strongly suspected intraoperatively, the histopathological examination revealed no invasion. This unexpected finding was attributed to the down staging following preoperative chemotherapy. The postoperative course was uneventful, and at present, 25 months postoperatively, the patient is doing well.
Safe and radical resection may be performed, with a temporary bypass, for lung cancer with marked invasion and infiltration of the aorta. The procedured described herein should be actively undertaken in suitable cases.
