Thoracic aortic endografting facilitates the resection of tumors infiltrating the aorta

Abstract

We and others have reported the early experience with off-label use of thoracic aortic endografts to facilitate the resection of tumors infiltrating the aorta. We describe our extended experience and long-term outcome using this innovative approach. Patients with preoperative suspected thoracic aortic infiltration who underwent endografting followed by en bloc tumor resection including the aortic wall were retrospectively reviewed and data were analyzed. Between 2008 and 2012, 5 patients (4 female) with a median age of 52 years (34-63 years) were included. Tumors infiltrating the aorta were non-small cell lung carcinomas (n=3) and sarcomas (n=2). Both patients with sarcoma had neoadjuvant radiation, whereas patients with non-small cell lung carcinomas had neoadjuvant (n=2) or adjuvant chemoradiation (n=1). Aortic endografting was performed 1 to 17 days before resection of the tumor. The proximal end of the stent-graft was deployed in the aortic arch (n=2) or the descending aorta (n=3). The tumor was resected en bloc in all patients and combined with chest wall and 2 to 3 levels of spinal resection in 4 of the 5 patients. Two patients with full-thickness aortic wall resection had additional buttressing of the defect. Cardiopulmonary bypass was never required. One patient had an empyema requiring debridements and thoracic window. After a median follow-up of 39 months (range, 9-62 months), all patients were alive and disease-free. None of them had overt endograft-related complications. Thoracic aortic endografting allowed safe en bloc resection of tumors invading the aortic wall. Therefore, the indication for thoracic aortic endografts could be extended to specific oncologic cases.