Thoracic Aortic Endografting Facilitates The Resection Of Tumors - - PowerPoint PPT Presentation

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Thoracic Aortic Endografting Facilitates The Resection Of Tumors - - PowerPoint PPT Presentation

Aug 13, 2022 293 likes •468 views

Thoracic Aortic Endografting Facilitates The Resection Of Tumors Infiltrating The Aorta S. Collaud 1 , T.K. Waddell 1 , K. Yasufuku 1 , G. Oreopoulos 2 , R. Rampersaud 3 , B. Rubin 2 , G. Roche- Nagel 2 , S. Keshavjee 1 , M. de Perrot 1 From the

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Thoracic Aortic Endografting Facilitates The Resection Of Tumors Infiltrating The Aorta

  • S. Collaud1, T.K. Waddell1, K. Yasufuku1, G. Oreopoulos2, R. Rampersaud3, B. Rubin2, G. Roche-

Nagel2, S. Keshavjee1, M. de Perrot1 From the Divisions of Thoracic Surgery1, Vascular Surgery2 and Orthopedic Surgery3, Sprott Department of Surgery1,2,3 and the Peter Munk Cardiac Centre2, Toronto General Hospital, University Health Network and the University of Toronto, Toronto, ON, Canada

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Thoracic Aortic Endografting Facilitates The Resection Of Tumors Infiltrating The Aorta

  • S. Collaud1, T.K. Waddell1, K. Yasufuku1, G. Oreopoulos2, R. Rampersaud3, B. Rubin2, G. Roche-

Nagel2, S. Keshavjee1, M. de Perrot1 From the Divisions of Thoracic Surgery1, Vascular Surgery2 and Orthopedic Surgery3, Sprott Department of Surgery1,2,3 and the Peter Munk Cardiac Centre2, Toronto General Hospital, University Health Network and the University of Toronto, Toronto, ON, Canada

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Thoracic Aortic Endografting Facilitates The Resection Of Tumors Infiltrating The Aorta

no conflict of interest to disclose

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Background

■ Aortic endografts:

  • aortic dissection
  • traumatic aortic injury
  • aneurysm rupture

■ More recently:

  • to facilitate resection of tumors invading the aorta1-3

1 Marulli et al. J Vasc Surg 2008, 2 Roche-Nagel et al. Ann Vasc Surg 2009, 3 Berna et al. Ann Thorac Surg 2011

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Aim

■ Describe our updated surgical experience and long-term

  • utcome with aortic endografting to facilitate the resection of

tumors invading the aorta

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Results

Patient Age Sex Pre-op Histology (y)p TNM Post- op # 1 43 F rad sarcoma

  • # 2

52 M

  • NSCLC

T4N0M0 ch-rad # 3 34 F rad sarcoma

  • # 4

63 F ch-rad NSCLC T4N0M0

  • # 5

54 F ch-rad NSCLC T3N0M0

  • ■ from 2008-2012
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Patient #1

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Patient #1

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Patient #1

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Patient #1

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Patient #2

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Patient #2

right to left common carotid artery bypass prior to covering of left carotid and subclavian arteries

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Results

Patient Stages Aortic endografting landing zone En bloc resection lung chest wall spine aorta resection reinforcement # 1 3 desc aorta w LUL ribs 7-9 hemi T7-9 adv-med-intima parietal pleura # 2 2 aortic arch LUL

  • adv-med
  • # 3

2 desc aorta LLL ribs 5-7 partial T5-6 adv-media

  • # 4

3 desc aorta LLL ribs 5-7 hemi T5-7 adv

  • # 5

2 aortic arch LLL ribs 5-8 partial T5-8 adv-med-intima bovine pericardium, lat dorsi muscle

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Patient #5

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Results

■ R0 resection in all patients ■ cardiopulmonary bypass was never used ■ at last follow-up (median=39 months, 9-62):

  • all alive and disease-free
  • BPF – empyema – non-union (Patient 1)
  • no overt endograft-related complication
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Conclusions

■ aortic endografting allows safe en bloc resection of tumors invading the aorta without cardiopulmonary bypass ■ indication for thoracic aortic endografts could be extended

to specific oncological cases

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Acknowledgments

American Association for Thoracic Surgery’s Evarts A. Graham Memorial Traveling Fellowship