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

Abstract

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.

Case Report: Uniportal robot-assisted thoracoscopic double-sleeve lobectomy after neoadjuvant immunotherapy

“…Compared with interrupted suture, running suture reduces the anastomosis time and avoids knot tangling. There has been a controversy on whether to wrap or not wrap the anastomosis by tissue flaps ( 20 ). Campisi et al conducted a retrospective multicenter analysis in 2021 to compare the postoperative outcomes between patients with or without bronchial wrapping and confirmed that sleeve resections may be performed safely without bronchial wrapping ( 21 ).…”

Overview of indications for pulmonary sleeve resection

“…Finally, extended sleeve resection (ESR) refers to a bronchoplastic operation whereby additional wedge resections or segmentectomies are performed in the remaining lobes following the initial sleeve resection. [ 4 - 9 ] Types of ESRs have been described:…”

Advances in Lung Cancer Therapy

“…Three studies focused on the surgical aspects in the treatment of advanced lung cancer [13][14][15].…”

“…Menna et al [15] performed a review on parenchymal sparing surgery for lung cancer, focusing on pulmonary artery (PA) reconstruction. In this review, the authors addressed some controversial aspects concerning the intraoperative and perioperative management of a sleeve resection with pulmonary artery reconstruction that may influence the outcome.…”