Lung auto-transplantation technique in the treatment for stage III central lung cancer

Abstract

To assess the feasibility and benefit of lung auto-transplantation technique in surgical treatment for stage III central lung cancer. From Aug 2000 to June 2007 eight patients, who were proved to be malignant pathologically through fiber-bronchoscope before operations and could not tolerate pneumonectomy, underwent lung auto-transplantations. The "cutdown" lower lobe was flushed with heparin solution at 20 degrees C. Since the length of resected bronchus or pulmonary artery involved by tumor was too long to perform tension-free anastomosis, we transplanted the inferior pulmonary vein to the proximal stump of the superior pulmonary vein. The bronchus and pulmonary artery were anastomosed in turn. Then radical hilar and mediastinal lymphadenectomy was performed. No anastomotic stoma fistula occurred in these 8 patients. Until Jan 2008, six of the eight patients who underwent lung autotransplantations, had been free of tumor recurrence for 7-90 months with good quality of life. And the median time was 33 months. Radioisotope scanning of the replanted lobes of three patients revealed normal perfusion 18, 24 and 72 months postoperatively. One patient received resection of the replanted lobe because of pulmonary vein thrombus on the 2nd day after transplantation, and died of respiratory failure caused by pulmonary relapse on 15th month postoperatively. Another patient died of brain metastases 31 months postoperatively. Lung auto-transplantation is an alternative technique for pulmonary preservation for patient with stage III centrally placed lung cancer, whose cardio-pulmonary functions is too poor to undergo pneumonectomy.