Permanent Cerebral Bypass Approach for Lung Cancer Resection with Aortic Arch Invasion

Abstract

We report a case of a 54-year-old man with T4N0M0 non-small cell lung cancer directly invading the thoracic wall and aortic arch. He underwent neoadjuvant chemotherapy followed by en bloc resection of the tumor, lung, chest wall and aortic arch. Perfusion was maintained through femoral-femoral cardiopulmonary bypass, with permanent bypass to the arch vessels to avoid separate extracorporeal cerebral circulation. Total reconstructions of the chest wall and aortic arch were completed without the need for cardiac arrest. The final pathological diagnosis was squamous cell carcinoma, T4N0M0. The patient was discharged without major complications and has been free of disease for 20 months postoperatively.

Key words

Lung cancer treatment (surgery - medical) - cardiopulmonary bypass - CPB - thoracic duct - aortic arch - chest wall - lung cancer surgery

References

• 1 Ohta M, Hirabayasi H, Shiono H et al. Surgical resection for lung cancer with infiltration of the thoracic aorta.  J Thorac Cardiovasc Surg. 2005;  129 804-808
• 2 Klepetko W. Surgical intervention for T4 lung cancer with infiltration of the thoracic aorta: are we back to the archetype of surgical thinking?.  J Thorac Cardiovasc Surg. 2005;  129 727-729
• 3 Rusch V W, Albain K S, Crowley J J et al. Neoadjuvant therapy: a novel and effective treatment for stage III b non-small cell lung cancer. Southwest Oncology Group.  Ann Thorac Surg. 1994;  58 290-294
• 4 Tsuchiya R, Asamura H, Kondo H, Goya T, Naruke T. Extended resection of the left atrium, great vessels, or both for lung cancer.  Ann Thorac Surg. 1994;  57 960-965
• 5 Rusch V W, Giroux D J, Kraut M J et al. Induction chemoradiation and surgical resection for non-small cell lung carcinomas of the superior sulcus: Initial results of Southwest Oncology Group Trial 9416 (Intergroup Trial 0160).  J Thorac Cardiovasc Surg. 2001;  121 472-483
• 6 de Perrot M, Fadel E, Mussot S, de Palma A, Chapelier A, Dartevelle P. Resection of locally advanced (T4) non-small cell lung cancer with cardiopulmonary bypass.  Ann Thorac Surg. 2005;  79 1691-1696
• 7 Macchiarini P, Kamiya H, Hagl C et al. Pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension: is deep hypothermia required?.  Eur J Cardiothorac Surg. 2006;  30 237-241
• 8 De Bakey M E, Beall Jr A C, Cooley D A, Crawford E S, Morris Jr G C, Garrett H E. Resection and graft replacement of aneurysms involving the transverse arch of the aorta.  Surg Clin North Am. 1966;  46 1057-1071