Surgical treatment of central lung cancer by lobar replantation

Abstract

To explore the feasibility, indication and method of surgical treatment of central-type lung cancer by lobar replantation. A retrospective study on the radical resection of 6 patients with stage III central-type lung cancer of the upper lobe by lobar replantation was made. Two patients underwent double-sleeve right upper and middle lobectomy, firstly. Since the length of resected bronchus or pulmonary artery involved by tumor was too long to perform tension-free anastomosis, we had to transplant the inferior pulmonary vein to the proximal stump of the supperior pulmonary vein, so the lower lobe was preserved. Another four patients underwent radical pneumonectomy, because the tumor had extended through the oblique fissure to the margin of the lower lobe. Subsequently, the lower lobe was isolated from the resected lungs and perfused with heparin solution ( 12 500 U/ 500 ml normal saline) for later replantation. After a radical systematic en-bloc mediastinal lymphadenectomy was performed, the preserved lower lobewas replanted. Followed up to Dec 2000, 3 patients had been alive for 43, 12 and 8 months separately with a good living quality. One case had tumor recurrence at 19th month and died at 23rd month postoperatively. One case died of tension pneumothorax caused by bronchopleural fistula on the 19th postoperative day. Another case received resection of the replanted lung for pulmonary arteriobroncho-pleural fistula on the 42nd day and died of respiratory failure caused by pulmonary infection on 14th month postoperatively. Lobar replantation is an alternative procedure of parenchyma-sparing in patients with stage III central lung cancer of the upper lobe whose cardiopulmonary function is too poor to undergo pneumonectomy.