Direct Cross-Clamping for Resection of Lung Cancer Invading the Aortic Arch or the Subclavian Artery

BACKGROUND: Resection of lung cancer infiltrating the aortic arch and/or the subclavian artery can be accomplished in selected patient under CardioPulmonary Bypass (CPB). Direct cross-clamping of the aortic arch and the left subclavian artery without CPB for radical resection of the tumor can be an alternative. Hereby, we present our experience with this technique.METHODS: Between October 2016 and May 2019, 9 patients (5 males, 4 females) underwent radical resection of lung cancer infiltrating the aortic arch (n=5) or the left subclavian artery (n=4) by direct cross-clamping technique. Seven left upper lobectomies, 1 left pneumonectomy and 1 left upper sleeve lobectomy were performed. Reconstruction of the aortic arch was performed by direct suturing or dacron patch, while the subclavian artery was reconstructed with a dacron conduit. Three patients received neoadjuvant chemotherapy.RESULTS: Patients' mean age was 64.7±13.3 years (range 36-78). Aortic arch resection was partial in all cases (adventitial in 1 and full-thickness in 4); left subclavian artery resection was adventitial in 2 patients and circumferential in 2. All the resections were complete. Prosthetic reconstruction was in 4 cases. Mean operative time was 130±25.6 minutes; mean vascular clamping time was 28.2±3.2 minutes. No mortality occurred. Major complication rate was 11.1 %. At a mean follow-up of 17±9 months (range 5-29) recurrence rate was 33.3%. Median survival was 20 months.CONCLUSIONS: Direct cross-clamping as an alternative to CPB for resection of lung cancer infiltrating the aortic arch or the subclavian artery is a feasible, safe and reliable procedure in selected patients.