Thoracic aortic endografting facilitates the resection of tumors infiltrating the aorta Academic Article uri icon

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abstract

  • OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

authors

  • Collaud, Stephane
  • Waddell, Thomas K
  • Yasufuku, Kazuhiro
  • Oreopoulos, George
  • Rampersaud, Raj
  • Rubin, Barry
  • Roche-Nagle, Graham
  • Keshavjee, Shafique
  • de Perrot, Marc

publication date

  • April 2014