[Use of the heart-lung machine in extra-cardial carcinoma surgery]

Implantation of a stent graft in the right pulmonary artery enables radical resection of a central endothelial sarcoma of the left pulmonary artery

In a patient with a huge endothelial sarcoma of the left pulmonary artery, we report successful implantation of a stent graft in the right pulmonary artery, including the pulmonary arterial trunk. This preoperative measure enabled a safe and radical left-sided pneumonectomy, including the tumor and the central parts of the left pulmonary artery. No major blood loss occurred, and neither use of a heart-lung machine nor cardiopulmonary bypass was necessary.

[Interdiscplinarity in thorax operations-from the viewpoint of the surgeon]

Occasionally, thoracic interventions may require interdisciplinary teamwork with plastic surgery, heart and vascular surgery, or neurosurgery. Thoracic wall defects following excision of primary wall tumors or recurrent, ulcerating tumors of the breast may require full-thickness myocutaneous flaps, which can best be done with the help of plastic surgeons. In case of infiltration of the heart or thoracic aorta, the en bloc principle of T4 lung tumors occasionally requires the help of heart surgeons, for open atrial resection using the heart-lung machine, or vascular surgeons for aortic graft interposition. Paravertebral dumbbell tumors occasionally may infiltrate to the intraspinal space and therefore need removal by neurosurgeons. When and why other specialists are required for an interdisciplinary approach to diseases of the chest has not been clearly defined. Therefore it is wise to gain informed consent from the patient about the roles of different specialists in interdisciplinary treatment for his disease.