RT Book, Section
A1 Blasberg, Justin D.
A1 Boffa, Daniel J.
A2 Sugarbaker, David J.
A2 Bueno, Raphael
A2 Burt, Bryan M.
A2 Groth, Shawn S.
A2 Loor, Gabriel
A2 Wolf, Andrea S.
A2 Williams, Marcia
A2 Adams, Ann
SR Print(0)
ID 1170410973
T1 Cardiopulmonary Bypass for Extended Thoracic Resections
T2 Sugarbaker’s Adult Chest Surgery, 3e
YR 2020
FD 2020
PB McGraw-Hill Education
PP New York, NY
SN 9781260026931
LK accesssurgery.mhmedical.com/content.aspx?aid=1170410973
RD 2023/03/20
AB To  completely  resect  a  primary  lung  cancer  that  extends  through  the  visceral  pleura  into  a  neighboring  structure,  the  pulmonary  and  extrapulmonary  portions  of  that  tumor  must  be  removed  as  a  single  specimen  (“en  bloc”).  Most  locally  invasive  tumors  are  amenable  to  en  bloc  resection,  including  cancers  that  involve  the  chest  wall,  vertebral  bodies,  or  diaphragm.  A  subset  of  extended  tumor  resections  for  T4  disease,  such  as  those  in  proximity  to  the  heart  or  central  vasculature,  may  be  facilitated  using  cardiopulmonary  bypass  (CPB).  CPB  can  make  surgery  easier  (by  decompressing  the  heart  and  creating  more  space  in  the  surgical  field),  and  some  reconstructions  are  not  technically  possible  without  it  (i.e.,  tumor  invasion  of  the  main  pulmonary  artery  [PA]).  The  use  of  CPB  also  has  some  negative  considerations  such  as  requirements  for  anticoagulation,  potential  for  tumor  dissemination,  and  technical  considerations  associated  with  cannulation.  More  specifically,  CPB  is  associated  with  prolonged  anesthesia,  longer  operations,  and  risk  for  cardiovascular  and  pulmonary  complications.1–4  Therefore,  we  reserve  the  use  of  CPB  for  those  cases  that  absolutely  cannot  be  performed  without  it.