Year 2014 Vol. 22 No 6

GENERAL AND SPECIAL SURGERY

S.A. YESKOV 1, V.V. ZHARKOV 2, Y.P. MARTYNOV1, V.V. EROKHOV1, .A. YUDINA 3, R.V. KASHANSKI 3

EXPERIMENTAL JUSTIFICATION FOR A NEW METHOD OF LEFT ATRIUM RESECTION

ME The 9th City Clinical Hospital: 1,
SE Republican Scientific and Practical Center of Oncology and Medical Radiology named after N.N. Alexandrov 2,
ME City Clinical Pathologoanatomic Bureau 3,
The Republic of Belarus

Objectives. To evaluate comparatively standard and original methods of the left atrium (LA) resection in pneumonectomy performed for the locally advanced lung cancer invading neighboring left atrium.
Methods. The study was performed in 32 adult cadavers. A comparison of LA wall areas excluded by vascular clamp in the application of traditional and developed ways of LA resection has been conducted.
Results. A new LA resection technique has been designed based on possibility of LA wall mobilization on the beating heart up to the mitral valve annulus by transection of fetal dorsal mesocardium remnant and dissection of the friable tissues between anterior wall of LA on the one side and pulmonary trunk and ascending aorta on the other. After the main stem bronchus and pulmonary artery transsection the vascular clamp should be applied to the approximated anterior and posterior walls of LA and located in transverse plane. One of the branches of the vascular clamp is placed along the vena cordis magna, the coronary sinus and the other is applied along the mobilization line limit of anterior wall. This technique has not accompanied by deformity of the orifice area of the opposite pulmonary veins. The worked out method permits to augment the exclusion area of the posterior wall of LA at the right sided pneumonectomy by 115,8% (on the average) and at the left sided - by 117,7% (on the average) in comparison with a standard method.
Conclusion. The developed technique of LA resection has the advantage of exclusion of a larger portion of the posterior LA wall compared to the conventional one that promotes security elevation and radicality of surgical intervention in cases of advanced lung carcinoma to the posterior wall of LA.
The designed method of the LA resection can be an alternative to its resection under conditions of the artificial blood circulation and thereby substantially reduce the cost of treatment.

Keywords: locally advanced lung cancer, left atrium, resection
p. 671-677 of the original issue
References
  1. Pitz CC, Brutel de la Riviere A, van Swieten HA, Westermann CJ, Lammers JW, van den Bosch JM.Results of surgical treatment of T4 non-small cell lung cancer. Eur J Cardiothorac Surg. 2003 Dec;24(6):101318.
  2. Tsuchiya R, Asamura H, Kondo H, Goya T, Naruke T.Extended resection of the left atrium, great vessels, or both for lung cancer. Ann Thorac Surg. 1994 Apr;57(4):96065.
  3. Galvaing G., Tardy MM., Cassagnes L. et al. Left atrial resection for T4 lung cancer without cardiopulmonary bypass: technical aspects and outcomes. The Annals of Thoracic Surgery. 2014 May;97(5):170813
  4. Spaggiari L, D' Aiuto M, Veronesi G, Pelosi G, de Pas T, Catalano G, de Braud F.Extended pneumonectomy with partial resection of the left atrium, without cardiopulmonary bypass, for lung cancer. Ann Thorac Surg. 2005 Jan;79(1):23440.
  5. Wang XX, Liu TL, Yin XR.Surgical treatment of IIIb-T4 lung cancer invading left atrium and great vessels. Chin Med J (Engl). 2010 Feb 5;123(3):26568.
  6. McAlpine Wallace A. Heart and Coronary Arteries: An Anatomical Atlas for Clinical Diagnosis, Radiological Investigation, and Surgical Treatment. Springer-Verlag, Berlin. Springer-Verlag Berlin Heidelberg New York 1975 p.134.
  7. Ho SY, Sanchez-Quintana D, Cabrera JA, Anderson RH. Anatomy of the left atrium: implications for radiofrequency ablation of atrial fibrillation. Cardiovasc Electrophysiol. 1999 Nov;10(11):152533.
  8. Ferguson ER Jr, Reardon MJ.Atrial resection in advanced lung carcinoma under total cardiopulmonary bypass. 2000;27(2):11012.
  9. Vaporciyan AA, Rice D, Correa AM, Walsh G, Putnam JB, Swisher S, Smythe R, Roth J.Resection of advanced thoracic malignancies requiring cardiopulmonary bypass. Eur J Cardiothorac Surg. 2002 Jul;22(1):4752.
  10. Wiebe K, Baraki H, Macchiarini P, Haverich A. Extended pulmonary resections of advanced thoracic malignancies with support of cardiopulmonary bypass. Eur J Cardiothorac Surg. 2006 Apr;29(4):57177.
  11. Es'kov SA, Zharkov VV. Khirurgicheskaia tekhnika rezektsii levogo predserdiia pri rake legkogo [Surgical method of resection of the left atrium in lung cancer]. Onkol Zhurn. 2012;6(2):3541.
Address for correspondence:
220116, Respublika Belarus,
g. Minsk, ul. Semashko, 8,
UO 9-ya gorodskaya klinicheskaya bolnitsa,
torakalnoe otdelenie,
tel. office: 375 17 376-81-28,
e-mail: 445e@mail.ru,
Yeskov Sergey Aleksandrovich
Information about the authors:
Yeskov S.A. A head of the thoracic department of ME The 9th City Clinical Hospital.
Zharkov V.V. MD, professor, a chief researcher of the thoracic oncopathology department with anesthesia group of SE Republican Scientific and Practical Center of Oncology and Medical Radiology named after N.N.Alexandrov.
Martynov Y.P. An intern of ME The 9th City Clinical Hospital.
Erokhov V.V. A surgeon of ME The 9th City Clinical Hospital.
Yudina O.A. PhD, an associate professor, a head of the general pathology department of ME City Clinical Pathologoanatomic Bureau.
Kashanski R.V. A pathologist of the general pathology department of ME City Clinical Pathologoanatomic Bureau.
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