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Giulia De Iaco
EP1.01 - Advanced NSCLC (ID 150)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Advanced NSCLC
- Presentations: 1
- Now Available
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
EP1.01-78 - T4 Lung Cancer Invading the Descending Thoracic Aorta: A Case Successfully Treated with Surgery by a Multidisciplinary Team (Now Available) (ID 2555)
08:00 - 18:00 | Author(s): Giulia De Iaco
T4 lung cancer invading the great vessels was usually considered a relative contraindication for radical surgery, because of technical difficulties and intra/postoperative bleeding complications. Recent studies have proved radical pneumonectomy or lobectomy together with aorta endograft positioning to have low mortality and morbidity rate and fairly good overall survival; however, only few cases have been reported in the literature. We report a case of T4 lung cancer invading the descending thoracic aorta (DTA) successfully treated with surgery by a multidisciplinary thoracic and vascular team.Method
A 60-year old male patient was admitted to our Department with a left upper lobe pulmonary tumor of 9 cm invading the DTA, as shown by preoperative computed tomography (CT) scan and magnetic resonance imaging (MRI). 18F-fluorodeoxyglucose positron emission tomography (FDG-PET)/CT total body scan revealed an uptake only at tumor site (SUV max 26.28) with no lymph nodes positivity. Preoperative spirometry values were FEV1 79%, FVC 82% and DLCO 72.5%. Pulmonary perfusion scintigraphy showed 65% for the right lung and 35% for the left one. We performed left pneumonectomy and hilar-mediastinal lymphadenectomy by posterolateral thoracothomy approach, observing about 5 cm long abventitial infiltration of DTA, 3 cm after left subclavian artery origin. An aortic endograft (GORE TAG Comformable Thoracic Stent Graft with ACTIVE CONTROL System) via left femoral artery was disposed 2 cm distal to the subclavian artery origin, then the infiltrated abventitial aortic wall (40% of the aortic circumference) was removed, leaving only the macroscopic healthy endothelium and protecting it with a Goretex mesh (BARD COMPOSIX E/X MESH).Result
The patient spent one night in intensive care unit (ICU), transfusing blood once. The only postoperative complication was a transitory atrial fibrillation pharmacologically treated. He was discharged 9 days after surgery. Pathologic analysis showed a non-mucinous lung adenocarcinoma invading the visceral pleura with a metastatic bronchial lymph node (pT4N1M0), with margins free of tumor. Chemotherapy and radiotherapy were administered and the patient is alive and in good condition 6 months after surgery, free of relapse.Conclusion
In selected cases, in young patients with good performance status, surgery for T4 lung cancer invading the DTA can successfully be accomplished, without complications, by an experienced multidisciplinary thoracic and vascular surgeons team, in high volume centers.
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