Berker ÖZKAN, Adalet DEMİR, Suat ERUS, Sedat ZİYADE, Murat KAPDAĞLI, Serhan TANJU, Başak SARAÇOĞLU, Erkan KABA, Alper TOKER

Pulmonary artery resections and reconstructions for lung cancer treatment: An anatomical-technical analysis and survival relationships

Amaç: Bu çalışmada günümüzde akciğer kanseri tedavisindenadir olarak uygulanmakta olan pulmoner artere (PA) yama veyauç uca anastomoz yöntemleri ile rezeksiyon ve rekonstrüksiyonameliyatlarının sonuçları bildirildi.Çalışmaplanı: Ocak 2005 - Ocak 2012 tarihleri arasında küçük hücrelidışı akciğer kanseri nedeniyle ameliyat edilen 712 hastanın 32sine(26 erkek, 6 kadın; ort. yaş 62±8 yıl; dağılım 39-80 yıl) lobektomi ve PAmajör rekonstrüksiyon cerrahisi (dördü otolog perikard yama, 10u dapolitetrafloroetilen greft ile yama olmak üzere 14üne parsiyel ve 18inesirkumferensiyal rezeksiyon) uygulandı.Bul gu lar: Medyan sağkalım 48±8 ay idi. Beş ve yedi yıllık sağkalımoranları sırasıyla %27 ve %9 idi. Ameliyata bağlı mortalite görülmedi.Morbidite oranı %41 (minör %31 ve majör %10) idi. Sağ taraflı ameliyatolan hastaların tümünde bronşiyal sleeve rezeksiyon da uygulanır iken,sol tarafta bu oran %59 idi (p=0.03). Double sleeve rezeksiyon oranı %47idi. Pulmoner artere yama cerrahisi yapılan hastalarda medyan sağkalımoranı 60±36 ay, beş yıllık sağkalım oranı ise %37 iken, sirkumferensiyalrezeksiyon ve uç uca anastomoz yapılan hastalarda medyan sağkalım43±13 ay, beş yıllık sağkalım oranı ise %22 bulundu (p=0.38). Yamauygulaması ile sirkumferensiyel rezeksiyon ve uç uca anastomoz grubuarasında komplikasyon açısından istatistiksel olarak anlamlı fark yoktu(p=0.808). Double sleeve rezeksiyon uygulanan hastalarda beş yıllıksağkalım oranı %16 iken, diğerlerinde bu oran %48 idi (p=0.282). Ayrıcasağkalımın tek değişkenli analizinde yaş (p=0.185), taraf (p=0.527),neoadjuvan tedavi (p=279), N durumu (p=0.878), adjuvant tedaviseçimi (p=0.978) ve metastaz gelişimi (p=0.471) açısından anlamlı birfark görülmedi. Kadın cinsiyeti (p=0.05), adjuvan tedavi (p=0.001) veameliyat sonrası komplikasyon gelişimi (p=0.038) uzun dönem sağkalımiçin pozitif öngördürücüler olarak bulundu.Sonuç: Pnömonektomiden sakınmak için uygulanan PA rezeksiyonlarıve rekonstrüksiyonları, düşük morbidite ve mortalite oranları ileuygulanabilen uygun ve etkili cerrahi işlemlerdir. Kadın cinsiyeti,ameliyat sonrası adjuvan onkolojik tedavi ve ameliyat sonrası süreçtekomplikasyon gelişmemesinin uzun dönem sağkalımı etkileyebileceğigörünmektedir.

Akciğer kanseri tedavisinde pulmoner arter rezeksiyon ve rekonstrüksiyonları: Anatomik-teknik analiz ve sağkalım ilişkisi

Background: This study aims to report the results of pulmonaryarterial (PA) resections and reconstructions with either a patch orend-to-end anastomosis for lung cancer which are currently rarelyused.Methods: Between January 2005 and January 2012, 712 non-small celllung cancer patients underwent surgery of which 32 (26 males, 6 females;mean age 62±8 years; range 39 to 80 years) had lobectomy and majorreconstructive surgery for PA (14 partial, including four PA reconstructionswith an autologous pericardial patch and 10 PA reconstructions with apolytetraflouroethylene graft and 18 circumferential).Results: The median survival was 48±8 months. Five and seven-yearsurvival rates were 27% and 9% respectively. No operative mortality wasseen. Morbidity rates were 41% (minor 31% and major 10%). All patientswith a right-sided resection had also a bronchial sleeve resectionswith a rate of 59% in the left lung (p=0.03). The rate of double sleeveresection was 47%. The median and five-year survival rates were 60±36months and 37% in the arterial patch plasty operations respectively,whereas it was 43±13 months and 22% in circumferential resections andend-to-end anastomosis patients, respectively (p=0.38). There was nostatistically significant difference in the complication rate between thecircumferential resections with patch plasty operations and end-to-endanastomosis (p=0.808). Five-year survival rate was 16% in double sleeveresections and 48% in others (p=0.282). Univariate analysis of survivaldemonstrated no significant differences in terms of age (p=0.185), side(p=0.527), neoadjuvant treatment (p=279), N status (p=0.878), type ofadjuvant treatment (p=0.978) and metastasis development (p=0.471).Female gender (p=0.05), adjuvant treatment (p=0.001) and developmentof postoperative complications (p=0.038) were identified as positivepredictors for long-term survival.Conclusion: Pulmonary arterial resections and reconstructions toprevent pneumonectomy are feasible and effective surgical procedureswith acceptable morbidity and mortality rates. Female gender,postoperative adjuvant oncological treatment and non-complicatedpostoperative course appear to be potential influencing factors onlong-term survival.

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