Lung carcinomas infiltrate the aorta mostly on the left side and are altogether rare. As an initial step, complete staging is performed and the results are evaluated in an interdisciplinary tumor board. If the patient’s general condition including cardiopulmonary reserves is sufficient, and if there is neither distant metastasis nor an N2 situation, surgical resection may be indicated. The option for neoadjuvant chemotherapy should always be taken into consideration. Depending on the anatomic tumor location, partial lung resection and resection of the affected aortic wall are performed employing a cardiopulmonary bypass. The resected aortic wall is replaced by a vascular prosthesis. In recent years, this proven procedure has partly been replaced by an alternative one, avoiding extracorporeal circulation. An endoaortic stent is implanted in the affected area followed by partial lung resection and resection of the diseased aortic wall. This new procedure has significantly reduced perioperative mortality and morbidity. With proper patient selection, long-term survival can be improved even in this complex malignoma.
肺癌主要从左侧浸润主动脉，但总体较为罕见。作为初始步骤，需完成全面分期检查，并在多学科肿瘤委员会中评估结果。若患者全身状况（包括心肺储备功能）良好，且无远处转移或N2淋巴结转移，可考虑手术切除。新辅助化疗方案应始终纳入考量范围。根据肿瘤解剖位置，可运用体外循环技术实施部分肺切除及受累主动脉壁切除术。切除的主动脉壁需以血管假体替代。近年来，这种成熟术式已部分被创新术式取代，新方法避免了体外循环的应用：先在受累区域植入主动脉内支架，随后进行部分肺切除及病变主动脉壁切除。这种创新术式显著降低了围手术期死亡率及并发症发生率。通过精准的患者筛选，即使面对此类复杂恶性肿瘤，也能有效改善患者的长期生存预后。
T4 Lung Carcinoma with Infiltration of the Thoracic Aorta: Indication and Surgical Procedure
肿瘤(癌症)患者之家