First artificial bronchus graft in a lung cancer patient successful

By Dr. Ananya Mandal, MDMar 3 2011

In a medical breakthrough French surgeons have grafted an artificial airway to save a lung afflicted by bronchial cancer in a 78-year-old man. The bronchi are the main tubes or airways used for taking air from the trachea to the two sides of the lung.

When the cancer affects the bronchus, surgeons typically remove a whole lung, as well as the bronchus itself. In more than a quarter of cases, this leads to death within three months of the operation. In this case the team led by thoracic and vascular surgeon Emmanuel Martinod removed the diseased part of the bronchus and grafted a replacement, thus saving the lung. The operation took three hours on October 28 2009 and entailed placing a small metal tube-shaped frame, or stent, which supported a section of artery taken from a deceased donor and frozen in a tissue bank. The advantage of aortal tissue is that it does not require anti-rejection drugs, which are not recommended for cancer patients, whose weakened immune system is less able to combat infection.

Martinod, a professor at the Avicenne Hospital in eastern Paris said, “The patient is doing very well… He needs regular monitoring, but he’s doing fine, he’s walking, he goes to his house in the country. “The patient has the respiratory capacity of an 80-year-old man with a history of smoking,” he said.

According to Alain Carpentier, a professor of bio-surgery who is also president of France’s Academy of Sciences, the tissue regrowth was “magical.” “The bronchus is regenerating,” he said, explaining that the transplanted aortal tissue had become a “matrix” or scaffold which was now being recolonised by bronchial cells. They were rebuilding the epithelium, a mucosal lining of the bronchus that cleanses the airways.

Details of this medical first are published in the review The Annals of Thoracic Surgery. The surgery culminated 10 years of research. Now 20 or 30 similar operations are being scheduled in an investigation to see whether the transplant should be enlisted in routine surgery for treating this form of lung cancer.