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Thorac Cardiovasc Surg 2021; 69(03): 240-245
DOI: 10.1055/s-0040-1714071
Original Thoracic

Preliminary Results of Extracorporeal Membrane Oxygenation Assisted Tracheal Sleeve Pneumonectomy for Cancer

Lorenzo Spaggiari 
1   Department of Thoracic Surgery, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
2   Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy
,
Giulia Sedda 
1   Department of Thoracic Surgery, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
,
Francesco Petrella 
1   Department of Thoracic Surgery, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
2   Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy
,
Marco Venturino
3   Department of Anesthesiology, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
,
Fabiana Rossi
4   Department of Cardiovascular Surgery, Centro Cardiologico Monzino IRCCS, Milano, Italy
,
Juliana Guarize 
1   Department of Thoracic Surgery, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
,
Domenico Galetta 
1   Department of Thoracic Surgery, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
,
Monica Casiraghi 
1   Department of Thoracic Surgery, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
,
Giorgio Lo Iacono 
1   Department of Thoracic Surgery, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
,
Luca Bertolaccini 
1   Department of Thoracic Surgery, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
,
Francesco Alamanni
4   Department of Cardiovascular Surgery, Centro Cardiologico Monzino IRCCS, Milano, Italy
5   Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy
› Author Affiliations Funding This work was partially supported by the Italian Ministry of Health with Ricerca Corrente and 5 × 1000 funds.
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Abstract

Objective Tracheal sleeve pneumonectomy is a challenge in lung cancer management and in achieving long-term oncological results. In November 2018, we started a prospective study on the role of extracorporeal membrane oxygenation (ECMO) in tracheal sleeve pneumonectomy. We aim to present our preliminary results.

Methods From November 2018 to November 2019, six patients (three men and three women; median age: 61 years) were eligible for tracheal sleeve pneumonectomy for lung cancer employing the veno-venous ECMO during tracheobronchial anastomosis.

Results Only in one patient, an intrapericardial pneumonectomy without ECMO support was performed, but cannulas were maintained during surgery. The median length of surgery was 201 minutes (range: 162–292 minutes), and the average duration of the apneic phase was 38 minutes (range: 31–45 minutes). No complications correlated to the positioning of the cannulas were recorded. There was only one major postoperative complication (hemothorax). At the time of follow-up, all patients were alive; one patient alive with bone metastasis was being treated with radiotherapy.

Conclusion ECMO-assisted oncological surgery was rarely described, and its advantages include hemodynamic stability with low bleeding complications and a clean operating field. As suggested by our preliminary data, ECMO-assisted could be a useful alternative strategy in select lung cancer patients.

Keywords

extracorporeal membrane oxygenation - tracheal sleeve pneumonectomy - lung cancer

Author Contribution

L. S. and F. A. contributed to the conception of the work. All authors contributed to data acquisition. D. G., M. C., F. P., and L. B. contributed to data analysis and interpretation. L. S. and G. S. contributed to drafting the work. F. P. and L. B. contributed to revising of the manuscript critically. All authors contributed to the final approval of the version to be published.




Publication History

Received: 23 March 2020

Accepted: 18 May 2020

Article published online:
19 August 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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