Author of

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  P3.24 - Poster Session 3 - Supportive Care (ID 160)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Supportive Care
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 12876

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    P3.24-023 - A huge lung carcinoma presenting with major respiratory distress is not necessarily a contraindication for surgical treatment, even when extended pneumonectomy is required. (ID 1468)

    09:30 - 09:30  |  Author(s): M. Schiltz
    • Abstract

    Background
    Pneumonectomies are usually considered contraindicated for advanced NSCLC.

    Methods
    A 49 year old female patient was admitted for acute severe respiratory distress requiring intubation and mechanical ventilation shortly after admittance. The patient was cachectic (BMI 16) with a hetero-anamnesis of Graves disease, 30 pack-years smoking and progressive dyspnea over weeks for which the patient did not seek medical advice prior to admission. Chest X-ray on admission showed a "white" left hemi-thorax and mediastinal shift to the right. Bronchoscopy showed tumor occlusion of the left main bronchus where biopsies revealed non-small cell lung cancer. CT-scan showed a huge tumor mass almost completely filling the left hemi-thorax and displacing the mediastinum to the right, a >3 cm subcarinal adenopathy, a small left pleural effusion and a likely invasion of the left axillary chest wall. Cerebral CT-scan was normal. In this hopeless seeming situation, the next of kin expressed their wish for an attempt at palliative surgery, given the chance that relieve from compression and circulatory shunt might bring the patient to a possible extubation and ability to communicate with their children, even if only for a short time.Figure 1

    Results
    Via median sternotomy and left hemi-clamshell incision an intra-pericardic, extrapleural pneumonectomy extended to ribs 3-5, pericardium and thymus was performed. Pathologic examination, showed G3 "non-small cell" lung cancer, TTF-1 positive, Ki67 index 90%, involvement of pericardium and positive pericardial fluid. Subcarinal and all other 20 lymph nodes were negative. pT3N0M1a (pleural cytology), R1. Postoperatively, the patient's state improved quickly to extubation but she later required a temporary tracheostomy (day 7) because of exhaustion and overall muscle weakness. She could be revalidated and discharged at post-operative day 74. At 9 months follow-up she is fully ambulatory and CT-scan shows no sign of recurrence. Figure 1

    Conclusion
    In exceptional circumstances, palliative resections up to extended extrapleural pneumonectomy may be justifiable.