Video-assisted transcatheter lung perfusion regional chemotherapy.

Objective: To establish a technique for performing isolated lung perfusion (ILP) under video-assisted thoracic surgery (VATS) to treat unresectable lung malignancies.

Methods: Under fluoroscopic and thoracoscopic guidance, five canine left lungs were isolated by means of an endovascular technique comprising pulmonary artery cannulation through the right femoral vein and pulmonary vein cannulation through the left auricular appendage (VATS-ILP). ILP was performed for 20 min at a flow rate of 30 ml/min with a high-dose cisplatin solution (50 microg/ml). Toxicity and pharmacokinetics of VATS-ILP were compared with those of conventional ILP performed in five additional lungs.

Results: VATS-ILP was performed safely without adverse reaction. Both VATS-ILP and conventional ILP delivered a high dose of cisplatin to the treated lung (total platinum concentration: 48+/-17 microg/g tissue for VATS-ILP vs. 51+/-19 microg/g tissue for conventional ILP, P>0.1) without significant systemic leakage (total platinum concentration: 0.4+/-0.1 microg/ml plasma vs. 0.5+/-0.2 microg/ml plasma, P>0.1). In addition, no significant differences were observed between the groups in the serum lactate dehydrogenase level, serum angiotensin-converting enzyme level, body weight change, or mid-term histological change following ILP. A significantly smaller thoracotomy was used for VATS-ILP than for conventional ILP (4.7+/-0.4 cm for VATS-ILP vs. 12+/-0.7 cm for conventional ILP, P<0.001) because VATS-ILP required neither arteriotomy nor venotomy.

Conclusions: We established a canine VATS-ILP model that showed pharmacokinetic potential similar to that of conventional ILP. A clinical trial of VATS-ILP with cytotoxic drugs is warranted.