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Thoracic endografts may allow safe resection of tumors in aorta

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Thoracic aortic endografting allowed safe en bloc resection of tumors invading the aortic wall, particularly for tumors that extended into the aortic wall and the spine, according to results of a retrospective study presented at the American Association for Thoracic Surgery Annual Meeting.

Five patients (four women) with suspected thoracic aortic infiltration underwent endografting and en bloc resection between 2008 and 2012. Median patient age was 52 years (range, 34-63).

Three patients had non–small cell lung cancer. Two of them underwent neoadjuvant radiation and one underwent adjuvant chemoradiation. Two patients had sarcoma, and both had undergone induction radiation prior to resection.

Aortic endografting was performed 1 to 9 days before resection, with the proximal end of the stent graft deployed in the aortic arch in two cases and the descending aorta in three cases. The tumor was resected en bloc in all patients, and was combined with chest wall and two to three levels of spinal resection in four of the five patients.

Two patients underwent full thickness aortic wall resection. Bovine pericardium was needed to cover the stent in one of them to avoid protrusion through the large defect and compromise of the proximal landing zone.

All patients survived the procedure without paraplegia and were discharged home alive. One patient developed an empyema that required debridement and thoracoplasty, but there was no overt endograft infection.

R0 resection was achieved in all patients. Median hospital stay was 16 days (range, 7-29). All patients were alive, disease-free and without complication from the endograft after a median follow-up of 30 months (range 3-52).

“We suggest that the indication for thoracic aortic endografts could be extended to specific oncological cases,” researcher Stéphane Collaud, MD, MSc, of Toronto General Hospital said in a press release. “This minimally invasive approach allowed safer removal of complex tumors invading the aorta without the need for a heart-lung machine.”

For more information:

Collaud S. Abstract #T4. Presented at: American Association for Thoracic Surgery Annual Meeting; May 4-8, 2013; Minneapolis.