Thoracic endografts successfully remove tumors invading the aorta

Placing a stent within the aorta facilitated the subsequent removal of a tumor in the aorta and eliminated the need for heart-lung bypass. The research, done in a small series of patients, was presented at 93rd American Association for Thoracic Surgery Annual Meeting in Minneapolis, Minnesota on May 8, 2013.

Potential metastasis of chest tumors may result in the tumor invading the aorta. Typically, surgically removing these tumors is very challenging and necessitates the support of a heart-lung machine. This leads to an increased risk of complications and death.

Endovascular grafts are inserted into blood vessels in the groin, and then threaded through the vasculature until they reach the aorta, where they prop up the vascular wall and keep the lumen open. Endovascular thoracic stent-grafts are indicated for use in aortic aneurysms, dissections, traumatic injuries, and rupture of the aorta. However, worldwide, these vessel prostheses have only been used anecdotally for helping to remove tumors invading the aorta.

The retrospective single-center study, conducted at the University of Toronto, included five patients with tumors infiltrating the aorta. An aortic endograft was inserted 1 to 9 days prior to tumor resection. Three patients had non-small cell lung carcinomas and two had sarcomas. The proximal end of the stent-graft was placed in the aortic arch or descending aorta. The tumor was resected en bloc (as one unit) in all patients and was combined with resection of the chest wall and spine in four of the five patients.

"We describe the off-label use of endografts in the oncological setting. We suggest that the indication for thoracic aortic endografts could be extended to specific oncological cases," said Stéphane Collaud, MD, MSc, a thoracic surgeon affiliated with Toronto General Hospital, University Health Network, and the University of Toronto. "This minimally invasive approach allowed safer removal of complex tumors invading the aorta without the need for a heart-lung machine."

After 9 to 62 months, all patients had survived and remained free of disease. There were no endograft-related complications.
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