Left lower lobectomy and partial preservation of segmental arteries of left upper lobe: A strategy to avoid pneumonectomy in selected cases.

Dario Amore,Carlo Curcio,Marcellino Cicalese,Carlo Bergaminelli,Dino Casazza,Simona Massa,Moana Nespoli,Alessandro Saglia,Marco Rispoli,Pasquale Imitazione

doi:10.1111/1759-7714.13155

Dario Amore, Carlo Curcio + Show 8 more

Open Access

https://doi.org/10.1111/1759-7714.13155

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Abstract

In this article we report two cases of left lower lobe lung cancer undergoing a surgical procedure that allowed the preservation of lung parenchyma and avoided pneumonectomy. The first case concerned a left lower lobe non‐small cell lung cancer with extracapsular spread in a metastatic interlobar lymph node and the second a left lower lobe lung cancer with invasion of the pulmonary artery at the origin of lobar branches to the lower lobe. In both cases, a lung‐sparing surgical treatment was preferred and a left lower lobectomy was performed with division of lingular arteries and the interlobar artery, preserving the remaining arterial branches to the upper lobe.

Highlights

The infiltration of the pulmonary artery by lung cancer and the extracapsular extension of interlobar lymph node metastasis remain one of the most challenging conditions encountered in thoracic surgery
Some authors have demonstrated that reconstructive parenchymal-sparing procedures provide the possibility of achieving a margin-negative resection, avoiding postoperative morbidity and mortality associated with pneumonectomy for patients with infiltration at the origin of the lobar branches of the pulmonary artery by operable non-small cell lung cancer (NSCLC), or for lung cancer patients with interlobar lymph node metastases.[2]
In the first case reported here, the primary tumor was located in the left lower lobe and a metastatic interlobar lymph node with extracapsular spread involved the segmental artery for the lingula

Summary

Introduction

The infiltration of the pulmonary artery by lung cancer and the extracapsular extension of interlobar lymph node metastasis remain one of the most challenging conditions encountered in thoracic surgery. Contrast-enhanced computed tomography (CT) scans revealed a mass measuring 60 x 40 mm in the left lower lobe and an enlarged left interlobar lymph node (Fig 1a,b).

Results

Conclusion