Resection and reconstruction of the left atrium with cardiopulmonary bypass for T4 non-small cell lung cancer.

Objective: Radical surgery for T4 non-small cell lung cancer, especially for those tumors invading the heart, poses a significant challenge for thoracic surgeons, as demonstrated by the paucity of previous reports. This study aimed to report our surgical technique and experience with this radical surgery that necessitated cardiopulmonary bypass and to assess the prognosis of these patients with locally advanced non-small cell lung cancer. Methods: This study included 4 patients with non-small cell lung cancer (enrolled between 2010 and 2020) who underwent en bloc tumor resection and reconstruction of the left atrium with cardiopulmonary bypass. The clinical features, preoperative assessment, surgical technique, and outcomes of these patients were reviewed. Results: All patients received complete R0 resection and reconstruction. The mean operative and cardiopulmonary bypass times were 370.5 ± 100.7 minutes and 20.3 ± 13.8 minutes, respectively. One patient died within 30 days after surgery, 2 patients died 46 days and 7 months postoperatively, and 1 patient is still alive 47 months postoperatively without recurrence or metastasis. Conclusions: In the contemporary era of targeted and immunotherapy, surgical intervention may offer a viable alternative for patients with T4 NSCLC involving the left atrium who have exhibited resistance to neoadjuvant therapeutic regimens.