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Eur J Cardiothorac Surg 2006;29:571-577
© 2006 Elsevier Science NL
Department of Thoracic and Cardiovascular Surgery, Hannover Medical School, 30623 Hannover, Germany
Received 3 August 2005; received in revised form 26 October 2005; accepted 31 October 2005.
* Corresponding author. Present address: Herz-, Thorax-, und herznahe Gefäßchirurgie, Klinikum der Universität Regensburg, Franz-Josef-Strauss-Allee 11, 93055 Regensburg, Germany. Tel.: +49 9406 284535; fax: +49 9406 284400. (Email: KarstenWiebe{at}t-online.de).
Objective: Complete resection of advanced pulmonary malignancies infiltrating the heart or the great vessels may require the application of cardiopulmonary bypass (CPB). Extracorporal circulation, however, is known to cause lung injury and may be harmful especially in pneumonectomies. Methods: Over a period of 10 years extended pulmonary resections requiring cardiopulmonary bypass were analyzed in a retrospective study. Results: From August 1993 to August 2003, 13 patients underwent an extended pulmonary resection for curative indications, requiring support by CPB. Underlying diseases were sarcomas (n = 8), non-small cell lung carcinomas (n = 3), and others (n = 2). Pneumonectomies were performed in nine and lobectomies in four cases. In the majority of cases, several cardiac structures, predominantly the left atrium (n = 9), were affected. In four patients (31%), the indication for a CPB-supported procedure was not electively planned, but made intraoperatively. Complete en-bloc resection (R0) was achieved in 12 of 13 cases (92%). The 30-day mortality rate was 15% (n = 2). Major complications observed were acute lung injury (n = 4), right heart failure (n = 1), and multi-organ failure (n = 1). The cumulative survival at 1, 3, and 5 years in patients presenting with sarcomas was 62.5% compared to 33%, 0%, and 0%, respectively, in patients with non-small cell carcinoma (n = 3). Conclusions: Our results encourage the application of CPB in extended pulmonary resections to achieve complete resections. In carefully selected patients, especially those with sarcomas, the radical surgical procedure associated with increased pulmonary complications allows for significantly prolonged survival and quality of life.
Key Words: Lung cancer surgery • Pulmonary sarcoma • Cardiopulmonary bypass • Acute lung injury • Inflammatory reactions • Complications
Abbreviations: ALI = acute lung injury • ARDS = acute respiratory distress syndrome • CPB = cardiopulmonary bypass • CT = computed tomography • ECMO = extracorporeal membrane oxygenation • ICU = intensive care unit • LA = left atrium • NMR = magnetic resonance imaging • NYHA = New York Heart Association • OR = operating room • PTFE = polytetrafluoroethylene • POD = postoperative day • RA = right atrium • RV = right ventricle • RVOT = right ventricular outflow tract
This article has been cited by other articles:
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  M. Zielinski and J. Kuzdzal Pulmonary resections for T4 non-small cell lung cancer with support of cardiopulmonary bypass. Eur. J. Cardiothorac. Surg., October 1, 2006; 30(4): 686 - 686. [Full Text] [PDF]
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K. Wiebe Reply to Zielinski and Kuzdzal. Eur. J. Cardiothorac. Surg., October 1, 2006; 30(4): 686 - 687. [Full Text] [PDF]
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W. Weder Editorial comment Extended pulmonary resections of advanced thoracic malignancies with support of cardio-pulmonary bypass - is surgery justified? Eur. J. Cardiothorac. Surg., April 1, 2006; 29(4): 577 - 578. [Full Text] [PDF]
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