Optimizing surgical management for pulmonary artery sarcoma: A 24-year single-center analysis.

Objective: Pulmonary artery sarcoma (PAS) is a rare and aggressive malignancy often misdiagnosed as chronic thromboembolic pulmonary hypertension. This study aimed to evaluate long-term outcomes after surgical treatment and to compare traditional surgical approaches with an integrated strategy developed at a high-volume center. Methods: We retrospectively reviewed 31 patients who underwent surgery for PAS at Fuwai Hospital between January 2000 and March 2024. Patients were categorized into 2 groups on the basis of surgical approach: traditional resection versus an integrated strategy involving imaging-guided planning, en bloc resection, selective pulmonary endarterectomy, and vascular reconstruction. Kaplan-Meier survival analysis was performed among 26 patients who survived the perioperative period. Results: The median follow-up duration was 38 months. Tumor recurrence occurred in 13 of 26 patients, with local recurrence in 9 and distant metastasis in 8. The 1-, 3-, and 5-year survival rates were 78.1% (95% confidence interval [CI], 60.0%-95.0%), 50.5% (95% CI, 30.2%-70.8%), and 19.9% (95% CI, 6.2%-33.6%), respectively, with a median overall survival of 44.0 months. Patients in the integrated surgery group demonstrated significantly improved survival compared with those undergoing traditional surgery (log-rank P = .0234), with no early postoperative deaths and lower recurrence rates. Conclusions: An integrated surgical approach combining radical resection, pulmonary endarterectomy, and vascular reconstruction may confer a survival advantage in selected patients with PAS. Early diagnosis and tailored surgical planning are critical to optimizing long-term outcomes in this rare and lethal disease.