THORACIC ENDOVASCULAR SURGERY FOR SURGICAL MANAGEMENT OF T4 LUNG TUMOR WITH THORACIC AORTIC INVOLVEMENT

Objective: Surgical treatment of primary lung T4 tumors is controversial especially when the cancer involves the descending thoracic aorta. We aimed to assess perioperative and midterm aortic related outcome of patients undergone aortic stent-graft implantation, followed by en- bloc surgical treatment of the involved aorta and lung cancer resection. Methods: From July 2017 to May 2020, we treated 5 patients, diagnosed with T4 lung cancer by the involvement of the descending thoracic aorta. When only the descending thoracic aorta is involved, a two stage procedure was considered, with aortic stent-graft implantation performed before tumor resection. One stage strategy, with stent-graft implantation carried out before thoracotomy, was preferred for patients with involvement of cardiac and/or other vascular mediastinal structures. Results: The mean age was 58.4 ± 6.2 years. All patients were affected by NSCLC. All five patients to completely cover the involved segment of aorta required a single stent-graft. Four patients underwent a two stages procedure. One patient, with involvement of the left inferior pulmonary vein, required a one stage en-bloc resection of the left lower lobe, aortic wall adventitia, left inferior pulmonary vein and reconstruction of the left atrial wall. Primary procedural success was achieved in all. At follow-up no patient developed aortic related complications. One patient died 2 years after surgery, due to local recurrence of the tumor. Conclusions: T4 lung resection combined with aortic stent-graft implantation can be safely performed. Postoperative and long-term outcome of these patients is related to the pulmonary disease, not to the aortic treatment.