Aim: To assess the feasibility and benefit of lung autotransplantation technique in surgical treatment for central lung cancer of upper lobe which could not tolerate pneumonectomy.
Methods: From August 2000 to August 2006 seven patients, who were proved to be malignant pathologically through fiber-bronchoscope before operation and could not tolerate pneumonectomy, underwent lung autotransplantations. Double-sleeve resection of the right upper and middle bilobectomy (or left upper lobectomy) and involved pulmonary artery was performed firstly. Because the length of resected bronchus or pulmonary artery involved by tumor was too long to perform tension-free anastomosis, we transplanted the inferior pulmonary vein to the proximal stump of the superior pulmonary vein. The bronchus and pulmonary artery were anastomosed in turn. Then radical hilar and mediastinal lymphadenectomy was performed.
Results: Until August 2006, among the seven patients who underwent lung autotransplantations, five patients had been free of tumor recurrence for 2 to 73 months with good quality of life. Radioisotope scanning of the replanted lobe of one patient revealed normal perfusion 6 years postoperatively. One patient received resection of the replanted lobe because of pulmonary vein thrombus on the second day after transplantation, and died of respiratory failure caused by pulmonary relapse on 15th month postoperatively. Another patient died of brain metastases 31 months postoperatively. No anastomotic stoma fistula occurred in these seven patients.
Conclusion: Lung autotransplantation is an alternative technique for pulmonary preservation for patients with centrally placed tumor of the upper lobe, whose pulmonary function is too poor to undergo pneumonectomy.