Abstract
BackgroundSalvage surgery is an effective therapeutic option for patients experiencing relapses after chemoradiotherapy for advanced-stage lung cancer or after high-dose radiotherapy for early-stage lung cancer. We report a case involving an emergent salvage surgery for a patient with massive hemoptysis who developed lung cancer recurrence after undergoing proton beam therapy 7 years prior to presentation.Case presentationA 70-year-old male patient was emergently admitted due to massive hemoptysis. He had undergone proton beam therapy for a stage I adenocarcinoma of the left upper lobe 7 years ago, and was receiving chemotherapy for local recurrence. We performed an emergent salvage pulmonary resection to achieve hemostasis. During the operation, we confirmed the presence of a left broncho-pulmonary arterial fistula, which was considered as the origin of the massive hemoptysis. We repaired the fistula between the pulmonary artery and left upper bronchus without incident; an orifice of the fistula at the left pulmonary artery was sutured using a non-absorbable monofilament, and the central portion of the orifice of the fistula at the left upper bronchus was closed with a mechanical stapling device. The postoperative diagnosis was of an adenocarcinoma—ypT3(pm1) N0M1a (dissemination)-IVA, ef1b. The patient has survived for over a year with the cancer in almost complete remission following the administration of an epidermal growth factor receptor tyrosine kinase inhibitor.ConclusionsEmergent salvage surgery demands high skill levels with optimal timing and correct patient selection. Our case suggested that the procedure played an important role in controlling serious bleeding and/or infectious conditions. Consequently, he could receive chemotherapy again and survive for over a year.
Highlights
Salvage surgery is an effective therapeutic option for patients experiencing relapses after chemoradiotherapy for advanced-stage lung cancer or after high-dose radiotherapy for early-stage lung cancer
We report a case of an emergent salvage surgery for a patient with massive hemoptysis who had lung cancer recurrence after undergoing proton beam therapy (PBT) 7 years before recurrence
Close observation revealed that the bleeding originated from the left main pulmonary artery through a broncho-pulmonary arterial fistula (BPAF)
Summary
We performed an emergent salvage lung resection due to massive hemoptysis after PBT for early-staged lung cancer and chemotherapy for local recurrence. Salvage surgery demands high skill levels in addition to optimal timing and patient selection; our results suggest that the procedure played an important role in controlling the life-threatening serious bleeding and/or infectious conditions, which saved the patient’s life. The patient could receive chemotherapy again, and achieved survival. To elucidate surgical feasibility and long-term survival, a larger series of emergent salvage surgeries for patients with pretreated lung cancer and life-threatening complications should be analyzed in future studies
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