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Abstract
Introduction. In thoracic surgery, the need for pulmonary artery resection and reconstruction arises primarily when the arterial wall is invaded by a lung tumor or metastatic lymph nodes, which occurs in 0.28–10 % of cases.
Aim. To conduct a retrospective analysis of the treatment outcomes of patients with non-small cell lung cancer (NSCLC) involving the pulmonary artery.
Materials and Methods. A retrospective analysis was conducted of 1,881 patients with morphologically confirmed NSCLC diagnosed between 2021 and 2024 in the Brest region of the Republic of Belarus. The primary endpoint was 3-year overall survival. The impact of TNM classification criteria (8th edition, 2017) and surgical treatment strategy on life expectancy and overall survival was assessed in NSCLC patients with pulmonary artery invasion.
Results. Among 163 (8.6 %) patients with NSCLC and evidence of pulmonary artery involvement, 117 (71.7 %) had stage I–III disease. Life expectancy in patients with stage IV NSCLC was 66 days (95 % CI: 38–247.5). The presence of the N3 criterion (HR 12.138; 95 % CI: 1.081–123.200, p = 0.041) contributed to an unfavorable outcome. In patients with NSCLC who underwent surgery for pulmonary artery involvement (excluding those with M1 and N3 criteria), the 3-year overall survival rate was 56.2 ± 7.59 % (log-rank test p = 0.9630; χ² = 0.2842). Regardless of the type of radical surgery performed, the 3-year overall survival rate was 13.9 times higher (p < 0.0001) than in patients whose treatment plan did not include surgery (4.03 ± 2.78 %). The chances of an unfavorable outcome following organ-sparing interventions were 1.61 times lower compared with pneumonectomy (Harrell's C-index = 0.629; 95 % CI: 0.544–0.714).
Conclusion. The presence of distant organ and lymph node metastases in patients with NSCLC and tumor invasion into the pulmonary artery negatively affects long-term treatment outcomes. Radical surgical treatment improves overall survival; however, regardless of tumor size and the pattern of lung and mediastinal lymph node involvement, preference should be given to organ-sparing interventions.
References
Жарков В.В. Еськов С.А., Ашуркевич Д.В. Радикальное лечение местно-распространенного немелкоклеточного рака легкого с поражением медиастинальных лимфоузлов. Онкологический журнал. 2016; 3(39): 21-30.-URL: https://www.elibrary.ru/item.asp?id=28771084. [Zharkov V.V., Yeskov S.A., Ashurkevich D.V. Radical treatment of locally-advanced IIIB (T4N2) stage non-small cell lung cancer. Oncological Journal. 2016; 3 (39): 21-30.-URL: https://www.elibrary.ru/item.asp?id=28771084 (In Rus)].
Sung H., Ferlay J., Siegel R.L., et al. Global Cancer Statistics. 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021; 71(3): 209-249.-DOI: https://doi.org/10.3322/caac.21660.-URL: https://pubmed.ncbi.nlm.nih.gov/33538338.
Ергнян С.М., Левченко Е.В., Барчук А.С. Комбинированные оперативные вмешательства при раке легкого с инвазией крупных сосудов и предсердия. Вестник хирургии имени И.И. Грекова. 2010; 171(1): 97-101-URL: https://cyberleninka.ru/article/n/kombinirovannye-operativnye-vmeshatelstva-pri-rake-lyogkogo-s-invaziey-krupnyh-sosudov-i-predserdiya. [Ergnyan S.M., Levchenko E.V., Barchuk A.S. Combined surgical interventions for lung cancer with invasion of great vessels and left atrium. Vestnik Chirurgii named I.I. Grekov. 2010; 171(1): 97-101-URL: https://cyberleninka.ru/article/n/kombinirovannye-operativnye-vmeshatelstva-pri-rake-lyogkogo-s-invaziey-krupnyh-sosudov-i-predserdiya (In Rus)].
Qian Q., Subbian S.K., Kofidis T. Total pulmonary artery replacement with an Avalus-Gelweave conduit in a patient with giant pulmonary artery aneurysm with pulmonary regurgitation. J Card Surg. John Wiley & Sons, Ltd. 2020; 35(5): 1122-1124.-DOI: https://doi.org/10.1111/jocs.14517.-URL: https://pubmed.ncbi.nlm.nih.gov/32176359.
Watanabe I., Hattori A., Fukui M., et al. Pulmonary artery reconstruction for non-small cell lung cancer: Surgical management and long-term outcomes. J Thorac Cardiovasc Surg. 2022; 164(4): 1200-1207.-DOI: https://doi.org/10.1016/j.jtcvs.2022.01.017.-URL: https://pubmed.ncbi.nlm.nih.gov/35219513.
Nguyen A., Solovei L., Marty-Ané C., et al. Arterial sleeve lobectomy: Does pulmonary artery reconstruction type impact lung function? Cancers (Basel). 2023; 15(20): 4971.-DOI: https://doi.org/10.3390/cancers15204971.-URL: https://pubmed.ncbi.nlm.nih.gov/37894338.
Vannucci J., Matricardi A., Potenza R., et al. Lobectomy with angioplasty: which is the best technique for pulmonary artery reconstruction? J Thorac Dis. 2018; 10(16): 1892-1898.-DOI: https://doi.org/10.21037/jtd.2018.05.174.-URL: https://pubmed.ncbi.nlm.nih.gov/30026976.
Ferguson M.K., Lehman A.G. Sleeve lobectomy or pneumonectomy: optimal management strategy using decision analysis techniques. Ann Thorac Surg. 2003; 76(6): 1782-1788.-DOI: https://doi.org/10.1016/s0003-4975(03)01243-8.-URL: https://pubmed.ncbi.nlm.nih.gov/14667584.
Berthet J.P., Boada M., Paradela M., et al. Pulmonary sleeve resection in locally advanced lung cancer using cryopreserved allograft for pulmonary artery replacement. J Thorac Cardiovasc Surg. 2013; 146(5): 1191-1197.-DOI: https://doi.org/10.1016/j.jtcvs.2013.07.003.-URL: https://pubmed.ncbi.nlm.nih.gov/23953718.
Balduyck B., Hendriks J., Lauwers P., Van Schil P. Quality of life after lung cancer surgery: a prospective pilot study comparing bronchial sleeve lobectomy with pneumonectomy. J Thorac Oncol. 2008; 3(6): 604-608.-DOI: https://doi.org/10.1097/JTO.0b013e318170fca4.-URL: https://pubmed.ncbi.nlm.nih.gov/18520798.
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