T4 Lung Carcinoma with Infiltration of the Thoracic Aorta: Indication and Surgical Procedure

SIMPLE SUMMARY: T4 lung carcinomas with aortic infiltration are rare tumors that pose a real challenge for the treatment team. Therefore, all available findings of the patient should be discussed in an interdisciplinary tumor board in order to coordinate the best possible procedure. In recent years, an increasing number of aortic stents have been implanted prior to tumor resection with good success. ABSTRACT: 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 In recent years, this proven procedure has partly been replaced by an alternative one, avoiding extracorporeal circulation.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.