Use of cardiopulmonary bypass in lung cancer surgery: focus on extended pulmonary resections for T4 non-small cell lung cancer

The use of cardiopulmonary bypass (CPB) in lung cancer surgery has become more prevalent and accepted over time. The original concerns of CPB induced pulmonary failure, tumor dissemination and immunocompromise remain unresolved up to today. The initial experience with combined cardiac and lung cancer resection procedures utilizing CPB may have laid the foundation for its use in the treatment of local regionally advanced non-small cell lung cancer (NSCLC). This chapter will focus on the use of CPB in the surgical resection of stage T4 NSCLC. A literature review demonstrates a published improved late survival in this setting with reasonable operative morality and complications. The surgical approach for involvement of specific anatomic structures including the carina, aorta, pulmonary veins/left atrium, right sided major veins/right atrium and main pulmonary arteries will be discussed. The specific situation of iatrogenically created “pseudo” T4 stage when NSCLC may invade a previously placed left internal mammary artery (LIMA) graft will also be presented. Finally, we will briefly discuss two other situations. That includes first the use of CPB when combined cardiac procedures and pulmonary resection are planned. Second we will address the use of CPB in the emergent setting of NSCLC resection.