Lobectomy With Artery Reconstruction and Pneumonectomy for Non-Small Cell Lung Cancer: A Propensity Score Weighting Study

Schiavon, Marco; Comacchio, Giovanni Maria; Mammana, Marco; Faccioli, Eleonora; Stocca, Francesca; Gregori, Darío; Lorenzoni, Giulia; Zuin, Andrea; Nicotra, Samuele; Pasello, Giulia; Calabrese, Fiorella; Dell’Amore, Andrea; Rea, Federico

doi:10.1016/j.athoracsur.2020.12.029

Cited by 6 publications

(5 citation statements)

References 21 publications

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“…When PA reconstruction is compared to PN, irrespective of neoadjuvant therapy, SL is constantly reported as a valid alternative, with lower short-term mortality and morbidity, without affecting long-term oncologic results. Schiavon et al [52] published in 2021 a propensity score weighting study comparing lobectomy associated to PA reconstruction with PN for NSCLC. PN was associated with a higher 30-day and 90-day mortality rate (p = 0.02 and p = 0.03, respectively) as well as with a higher incidence of major complications (p = 0.004).…”

Section: Short-term and Long-term Resultsmentioning

confidence: 99%

Parenchymal Sparing Surgery for Lung Cancer: Focus on Pulmonary Artery Reconstruction

Menna

Rendina

D’Andrilli

2022

Cancers

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Reconstruction of the pulmonary artery (PA) associated with lobectomy for the radical resection of lung cancer has been progressively gaining diffusion in lung cancer surgery as a safe and effective therapeutic option that may allow radical resection when lobectomy is not technically feasible, avoiding pneumonectomy. There are some controversial aspects concerning the intraoperative and perioperative management of a sleeve resection with PA reconstruction that may influence the outcome. In the present article, the authors have analyzed some of the main technical and oncological aspects to take stock of what they have learned from their lung-sparing operations experience over time. PA reconstruction may require prosthetic materials including different options with variable cost. A main concern in vascular reconstructive procedures is avoiding tension on the anastomosis. When PA reconstruction is required, appropriate anticoagulation management is crucial. Results from the main literature data confirm the reliability of lobectomy associated with PA reconstruction in terms of perioperative morbidity and long-term survival. Sleeve lobectomy and PA reconstruction can be performed safely and effectively even after induction therapy.

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Section: Short-term and Long-term Resultsmentioning

confidence: 99%

Parenchymal Sparing Surgery for Lung Cancer: Focus on Pulmonary Artery Reconstruction

Menna

Rendina

D’Andrilli

2022

Cancers

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“…Regarding the surgery type, extensive resections such as pneumonectomy in early-stage NSCLC contributed unfavorable outcomes and severer morbidity compared with lobectomy [ 142 , 143 ]. The pathological responses are achieved in part NSCLC patients receiving neoadjuvant ICIs, and surgery with more pulmonary volume may be considered and explored in future studies.…”

Section: Future Perspectives: the Challenges Of Immunotherapy In Surgically Resectable Nsclcmentioning

confidence: 99%

Immunotherapy and Vaccination in Surgically Resectable Non-Small Cell Lung Cancer (NSCLC)

Chiu

Lin

et al. 2021

Vaccines

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Early-stage NSCLC (stages I and II, and some IIIA diseases) accounts for approximately 30% of non-small cell lung cancer (NSCLC) cases, with surgery being its main treatment modality. The risk of disease recurrence and cancer-related death, however, remains high among NSCLC patients after complete surgical resection. In previous studies on the long-term follow-up of post-operative NSCLC, the results showed that the five-year survival rate was about 65% for stage IB and about 35% for stage IIIA diseases. Platinum-based chemotherapy with or without radiation therapy has been used as a neoadjuvant therapy or post-operative adjuvant therapy in NSCLC, but the improvement of survival is limited. Immune checkpoint inhibitors (ICIs) have effectively improved the 5-year survival of advanced NSCLC patients. Cancer vaccination has also been explored and used in the prevention of cancer or reducing disease recurrence in resected NSCLC. Here, we review studies that have focused on the use of immunotherapies (i.e., ICIs and vaccination) in surgically resectable NSCLC. We present the results of completed clinical trials that have used ICIs as neoadjuvant therapies in pre-operative NSCLC. Ongoing clinical trials investigating ICIs as neoadjuvant and adjuvant therapies are also summarized.

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“…Initially performed on patients with impaired cardiopulmonary reserves [3], this parenchymal-sparing technique is now performed on all patients where anatomical conditions allow complete resection [4]. Growing evidence suggests that arterial sleeve lobectomy is associated with lower postoperative complications, long term morbi-mortality [5][6][7], and better quality of life [8] when compared to pneumonectomy, even after neoadjuvant therapy [9]. However, few studies have considered the lung perfusion, respiratory function, and patency outcomes of sleeve procedures.…”

Section: Introductionmentioning

confidence: 99%

Arterial Sleeve Lobectomy: Does Pulmonary Artery Reconstruction Type Impact Lung Function?

Nguyen,

Solovei,

Marty-Ané

et al. 2023

Cancers

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Background: The aim of this single-center retrospective cohort study was to assess the impact of arterial reconstruction technique on lung perfusion. The second objective was to ascertain the functional validity of arterial sleeve lobectomy. Method: Between January 2001 and December 2020, a total of 81 patients underwent lobectomy with pulmonary artery (PA) reconstruction for lung cancer at the University Hospital of Montpellier. After excluding patients with an incomplete postoperative pulmonary function test, we conducted a comparative analysis of the preoperative and postoperative functional outcomes (FEV1) of 48 patients, as well as the preoperative and postoperative Technetium99m scintigraphic pulmonary perfusion results of 28 patients. Then, we analyzed postoperative perfusion results according to the pulmonary artery reconstruction techniques use. Results: PA reconstruction types were as follows: 9 direct angioplasties (19%), 14 patch angioplasties (29%), 7 end-to-end anastomoses (15%), 6 prosthetic bypasses (12%), 11 arterial allograft bypasses (23%), and 1 custom-made xenopericardial conduit bypass. Regardless of the type of vascular reconstruction performed, the comparative analysis of lung perfusion revealed no significant difference between the preoperative and postoperative perfusion ratio of the remaining parenchyma (median = 29.5% versus 32.5%, respectively; p = 0.47). Regarding the pulmonary functional test, postoperative predicted FEV1 significantly underestimated the actual postoperative measured FEV1 by about 260 mL (11.4%) of the preoperative value. The patency rate was 96% and the 5-year overall survival was 49% for a mean follow up period of 34 months. Conclusion: Lobectomy with PA reconstruction is a valid parenchymal-sparing technique in terms of perfusion and respiratory function.

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Lobectomy With Artery Reconstruction and Pneumonectomy for Non-Small Cell Lung Cancer: A Propensity Score Weighting Study

Cited by 6 publications

References 21 publications

Parenchymal Sparing Surgery for Lung Cancer: Focus on Pulmonary Artery Reconstruction

Parenchymal Sparing Surgery for Lung Cancer: Focus on Pulmonary Artery Reconstruction

Immunotherapy and Vaccination in Surgically Resectable Non-Small Cell Lung Cancer (NSCLC)

Arterial Sleeve Lobectomy: Does Pulmonary Artery Reconstruction Type Impact Lung Function?

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