P3.16-052 Use of Decellularised Porcine Intestinal Submucosa Extracellular Matrix in Airway Reconstruction to Enable Lung-Sparing Oncological Surgery

Abstract

Reconstruction of the airways following tracheal resection, tracheo-oesophageal complications and lung-sparing oncological surgery is challenging. Airway reconstruction materials ideally must possess balanced properties of rigidity, flexibility and have an intact surface of epithelium to maintain a functional airway. A novel approach is the use of bio-scaffolds which allow regeneration of respiratory epithelium and eliminate the need for immunosuppressive treatment. Initial experiences with decellularised porcine small intestine submucosa extracellular matrix (CorMatrix®) as a scaffold for vascular, cardiac and pericardial tissue repair and reconstruction has been encouraging. The properties of extracellular matrix are potentially suitable for airway reconstruction. We initially used the bio-scaffold for repairing tracheal defects and tracheo-oesophageal fistulae (n=6). We then extended its use to reconstruct distal airways to facilitate lung-sparing oncologic resections of intermediate grade lung tumours (n=3). These patients would otherwise have required pneumonectomy (Case 1 and 2) or bi-lobectomy in a patient with borderline lung function (Case 3). We describe our experience using extracellular matrix for airway reconstruction in lung-sparing oncological surgery. Three patients underwent complex sleeve resections with varying degrees of bronchial airway reconstruction using extracellular matrix. The lung tumours were: (1) muco-epidermoid tumour of the left upper lobe and left main bronchus; (2) typical carcinoid of the right main bronchus; (3) typical carcinoid of the intermediate bronchus and right middle lobe. All patients underwent frozen section pathology examination at the time of surgery and formal histology confirmed pT1N0 and R0 resection status. There were no perioperative complications. All patients underwent bronchoscopy prior to discharge and serial bronchoscopies were carried out 6 weeks, 3 months and at >1 year. All patients had complete integration of the scaffold by epithelialisation and the patch was not evident at 3 months. All segmental bronchi were widely patent. At 18 months there was no tumour recurrence. The use of decellularised porcine intestinal submucosa extracellular matrix (CorMatrix®) as a bio-scaffold is safe and shows remarkable epithelialisation and integrity. It is an option for airway reconstruction to facilitate lung-sparing surgery without compromising oncologic margins.