Sleeve lobectomy plus arterioplasty of pulmonary artery or angioplasty of superior vena cava for lung cancer

Objective: To analyze the surgical results of sleeve lobectomy plus arterioplasty of pulmonary artery (PA) or angioplasty of superior vena cava (SVC) for lung cancer and to discuss the T grade of tumor invading extrapericardial PA. Methods: We retrospectively reviewed the data from 53 patients with lung cancer who received sleeve lobectomy plus arterioplasty of PA or angioplasty of SVC in our hospital from September 1981 to January 2007. There were 42 males and 11 femals, with a median age of 59 years (range 33-71). According to the invading site, these patients were divided into two groups: the tumor invading superior vena cava group and the tumor invading pulmonary artery group. And according to pathological lymph node status, these patients were divided into three groups: N₀, N₁ and N₂ group. Results: Of the 53 patients, 41 received sleeve lobectomy plus arterioplasty of PA (13 sleeve resection and 28 tangential resection); and 12 received angioplasty of SVC (3 sleeve resection and 9 tangential resection). The complication rate was 15.1%(8/53). The 5-year survival was 38.5% for all of the patients, 42.9% for patients in the PA group and 22.2% for patients in the SVC group. Pathological lymph node status significantly influenced the survival period (10 months in N2 group, 24 months in NL group, and 26 months in N0 group. P<0.05). Cox regression analysis showed that pathological lymph node status was an independent prognostic factor (P =0.002, RR =2.836, 95% CI:1.330-6.049). Conclusion: For patients with lung cancer, lobectomy plus arterioplasty of PA or angioplasty of SVC can be accomplished safely and the postoperative complication rate is acceptable. Patients with pathological N_0-1 lung cancer may benefit from surgical treatment. Before surgery, we should carefully evaluate the mediastinal lymph node status. Tumor invading extrapericardial PA should be defined as T2.