Abstract
Extracorporeal assistances are exponentially used for patients, with acute severe but reversible heart or lung failure, to provide more prolonged support to bridge patients to heart and/or lung transplantation. However, experience of use of extracorporeal assistance for pulmonary resection is limited outside lung transplantation. Airways management with standard mechanical ventilation system may be challenging particularly in case of anatomical reasons (single lung), presence of respiratory failure (ARDS), or complex tracheo-bronchial resection and reconstruction. Based on the growing experience during lung transplantation, more and more surgeons are now using such devices to achieve good oxygenation and hemodynamic support during such challenging cases. We review the different extracorporeal device and attempt to clarify the current practice and indications of extracorporeal support during pulmonary resection.
Highlights
Advanced pulmonary cancers invading vital structure such as heart, great vessels, or carina cancer are generally considered as unresectable and incurable
Cardio-pulmonary bypass, extracorporeal membrane oxygenation, and pumpless extracorporeal lung assist have their place in the general thoracic surgery considering that a growing number of patients will benefit complex resection due to the advance in oncological treatment and improvement in surgical and anesthesic techniques
Selected patients with tumor involvement of the heart or great vessels should be resected on cardio-pulmonary bypass (CPB) with acceptable mortality and morbidity
Summary
Advanced pulmonary cancers invading vital structure such as heart, great vessels, or carina cancer are generally considered as unresectable and incurable. Complete resection in healthy tissue may be compromised due to the proximity of the tumors to vital organs [1, 2]. Palliation with chemotherapy and/or radiotherapy is the principal means of treatment [1, 2]. Multimodality approach with combination of both chemotherapy and radiotherapy may downstage some patients with locally advanced pulmonary cancer. In highly selected patients with specific anatomic conditions, complete R0 resection for locally advanced tumor has been reported with prolonged survival and, on occasion, resulted in cure [4,5,6]. Conventional techniques frequently do not allow for complete resection of advanced pulmonary tumors invading the heart or great vessels.
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