Author of

• 15343

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  P3.03 - Poster Session/ Treatment of Locoregional Disease – NSCLC (ID 214)

  • Event: WCLC 2015
  • Type: Poster
  • Track: Treatment of Locoregional Disease – NSCLC
  • Presentations: 1
  • Moderators:
  • Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)

  • 15352

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    P3.03-009 - A Case of Completion Pneumonectomy Performed Through Mid-Sternal Incision and Posterolateral Incision (ID 1114)

    09:30 - 09:30  |  Author(s): S. Fujino
    • Abstract

    Background:
    We report a case of completion pneumonectomy (CP) for recurrent lung cancer in which we resected the residual left lower lobe through posterolateral incision following confirmation of resectability of residual lung and no mediastinal lymph node metastasis through mid-sternal incision.
    
    Methods:
    [Case] A 71 year-old-man who underwent left upper sleeve lobectomy 2 years ago (squamous cell carcinoma, pT2bN1M0 2B) complained chronic coughing and sputum. Bronchofibroscope and chest computed tomography (CT) revealed a local recurrence at the left main bronchus and surrounding tissue of left pulmonary artery. No distant metastasis was pointed out by CT and other examinations. The patient’s pulmonary function was good (VC 3.29L, FEV1 .0 2.05L) and the predictive FEV1 .0 was 1.94L by the ventilation-perfusion scintigraphy. [Surgery] We added a mid-sternal incision in the supine position and confirmed no mediastinal lymph node metastasis and the resectability of left main pulmonary artery, then we cut the left main pulmonary artery in the pericardial cavity with exposing trachea, tracheal bifurcation and left main bronchus. After closing mid-sternal incision, the patient was converted into the right decubitus position and added posterolateral incision. After having separated the lower pulmonary vein and the stump of upper pulmonary vein in a pericardium, we exfoliated and cut left main bronchus and removed the residual left lower lobe. The operation time was 13 hours and 7 minutes and total blood loss was 2.23L. Postoperative course was almost uneventful and he left our hospital on the 30th postoperative day. He has no recurrence or metastasis 12-months after surgery.
    
    Results:
    [Discussion] It is said that the incidence of serious complications after CP extends to 18.4~40.7% and the incidence of bronchial fistula is over 10 percent. Because the survival rate is reported with 38.9~48.3% at 3-year and 16.9~48% at 5-year, careful adaptation decision is necessary.
    
    Conclusion:
    [Concluding remarks] Our approach to confirm the resectability and no mediastinal lymph node metastasis through mid-sternal incision is useful to make final decision of indication for CP. In addition, there is an advantage that intrathoracic operation is easy to perform because hilar region is handled beforehand through mid-sternal incision.