Arterial Sleeve Lobectomy: Does Pulmonary Artery Reconstruction Type Impact Lung Function?

SIMPLE SUMMARY: Lung cancer is the second most frequent tumor worldwide. In cases of pulmonary artery invasion, arterial sleeve lobectomy has progressively gained acceptance as an advantageous alternative to pneumonectomy, but few studies have considered lung perfusion and respiratory function. This single-center retrospective cohort study aimed to assess the impact of arterial reconstruction techniques on lung perfusion and respiratory function. Between January 2001 and December 2020, a comparative analysis of 48 patients’ preoperative and postoperative functional outcomes (FEV(1)) and 28 patients’ preoperative and postoperative lung perfusion results was conducted. Regardless of the type of vascular reconstruction, the study revealed no significant difference between the perfusion ratio of the remaining parenchyma before and after surgery. Moreover, arterial reconstruction did not negatively affect the expected postoperative respiratory function. Arterial sleeve lobectomy is a valid parenchymal-sparing technique in terms of perfusion and respiratory function. ABSTRACT: Background: The aim of this single-center retrospective cohort study was to assess the impact of arterial reconstruction technique on lung perfusion. The second objective was to ascertain the functional validity of arterial sleeve lobectomy. Method: Between January 2001 and December 2020, a total of 81 patients underwent lobectomy with pulmonary artery (PA) reconstruction for lung cancer at the University Hospital of Montpellier. After excluding patients with an incomplete postoperative pulmonary function test, we conducted a comparative analysis of the preoperative and postoperative functional outcomes (FEV(1)) of 48 patients, as well as the preoperative and postoperative Technetium99m scintigraphic pulmonary perfusion results of 28 patients. Then, we analyzed postoperative perfusion results according to the pulmonary artery reconstruction techniques use. Results: PA reconstruction types were as follows: 9 direct angioplasties (19%), 14 patch angioplasties (29%), 7 end-to-end anastomoses (15%), 6 prosthetic bypasses (12%), 11 arterial allograft bypasses (23%), and 1 custom-made xenopericardial conduit bypass. Regardless of the type of vascular reconstruction performed, the comparative analysis of lung perfusion revealed no significant difference between the preoperative and postoperative perfusion ratio of the remaining parenchyma (median = 29.5% versus 32.5%, respectively; p = 0.47). Regarding the pulmonary functional test, postoperative predicted FEV(1) significantly underestimated the actual postoperative measured FEV(1) by about 260 mL (11.4%) of the preoperative value. The patency rate was 96% and the 5-year overall survival was 49% for a mean follow up period of 34 months. Conclusion: Lobectomy with PA reconstruction is a valid parenchymal-sparing technique in terms of perfusion and respiratory function.