Abstract
BackgroundOnly few reports exist on malignant thoracic neoplasms that require cardiopulmonary bypass during resection. We aimed to investigate the early and late clinical outcome of these patients.MethodsPatients with thoracic malignancies that underwent surgery between 2002 and 2014 were analyzed. All patients had cardiopulomonary bypass support during resection. Clinical and perioperative data was retrospectively reviewed for outcome and overall survival.ResultsFifteen patients (12 female, mean age of 55 ± 15 years, range 24 to 80 years) were identified. Eleven (8 female) were diagnosed with primary thoracic malignomas and four with metastases. Three patients died early postoperatively. Patients diagnosed with sarcoma had a significantly worse outcome than non-sarcoma patients (83.3 ± 15.2 % after 1 year, 31.3 ± 24.5 % after 5 years vs. 83.3 ± 15.2 % after 1 year, 0 ± 0 % after 5 years, p = 0.005).ConclusionsMalignancies with extension into cardiac structures or infiltration of great vessels can be resected with cardiopulmonary bypass support and tolerable risk. Carefully selected patients can undergo advanced operative procedures with an acceptable 1-year-survival, but only few patients achieved good long-term outcome.
Highlights
Few reports exist on malignant thoracic neoplasms that require cardiopulmonary bypass during resection
Preoperative data Eleven (8 female) patients were diagnosed with primary thoracic malignancies and 4 patients (3 female) with metastatic disease infiltrating cardiac structures and/or great vessels (Table 1)
Surgical access to the mediastinum and thoracic cavity was guaranteed through median sternotomy (n = 8), clamshell-incision (n = 4) and lateral thoracotomy (n = 3)
Summary
Few reports exist on malignant thoracic neoplasms that require cardiopulmonary bypass during resection. Thoracic malignancies invading the mediastinum, heart or great vessels are rare and treatment including radical resection challenges oncological therapists. Primary mediastinal neoplasms without invasion into adjacent structures are generally of non-cardiac origin, such as thymoma, lymphoma or neurogenic tumors. Tumors that infiltrate directly into the heart, lung, aorta or vena cava are either primary cardiac malignancies or metastases of distant malignoma. The most common primary cardiac tumors are sarcoma (especially rhabdomyosarcoma or angiosarcoma) and lymphoma [1,2,3,4,5,6]. Once cardiac structures or great vessels are widely infiltrated, patients are merely treated in only a palliative setting due to an unresectable situation.
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