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En Bloc Resection of Pancoast Tumor with Adjuvant Aortic Endograft and Chemoradiation
Tony Lu, M.D.¹, Uwe M. Fischer M.D., Ph.D¹, Rex A. Marco, M.D.³, Joseph J. Naoum, M.D.¹, Michael J. Reardon, M.D.¹, Alan B. Lumsden, M.D.¹, Shanda H. Blackmon, M.D., MPH^2
1Methodist DeBakey Heart & Vascular Center and ²Department of Surgery, Houston Methodist Hospital,
³Department of Orthopedic Surgery, University of Texas Medical School, Houston, Texas
Abstract
Objectives: Pancoast tumors frequently require a multidisciplinary approach to therapy and are still associated with high morbidity and mortality. Due to their sensitive anatomic location, complex resections and chemoradiation regimens are typically required for treatment. Those with signs of aortic invasion pose an even greater challenge, given the added risks of cardiopulmonary bypass for aortic resection and interposition. Placement of an aortic endograft can facilitate resection if the tumor is in close proximity to or is invading the aorta. Prophylactic endografting to prevent radiation associated aortic rupture has also been described.
Methods/Results: We report the case of a 60 year old female with a left upper lobe undifferentiated non-small cell carcinoma encasing the subclavian artery with thoracic aorta and bony invasion (Figure left). Following carotid-subclavian bypass, resection of the lung with en bloc resection of the affected ribs and vertebral bodies was achieved (Figure right). The aorta was prophylactically reinforced with a Gore TAG thoracic endograft prior to adjuvant chemoradiation. The patient remains disease free at over five years follow-up after completing her treatment course.
Conclusion: Endovascular stenting with subsequent chemoradiation may prove to be a viable alternative to palliation or open operative management and prevention of aortic injury during tumor resection and/or adjuvant therapy in select patients with aortic involvement.