MID­term results of the urgent right lung complex reconstructive tracheobronchial resection in a patient with exacerbated central lung cancer (clinical case)

Abstract

Introduction. Treatment of patients with central non-small-cell lung cancer (NSCLC) complicated by recurrent hemophtysis is an urgent problem in oncology and thoracic surgery. The aim of this study is to demonstrate the possibility of performing radical organ-preserving surgery (right upper lobectomy with resection of the carina) in a patient with central NSCLC complicated by life-threatening pulmonary hemorrhage. Material and methods. A 64-year-old patient was hospitalized in our thoracic surgery department with grade IB hemophtysis for emergency indications. According to the results of the examination and data from rigid bronchoscopy, an infiltrative peribronchial tumor of the right upper lobe bronchus spreading to the right main bronchus, intermediate bronchus and distal trachea was revealed. According to vital indications, the patient underwent video-assisted mediastinal lymphadenectomy (VAMLA) followed by the right upper lobectomy with carinal resection and circular anastomosis between the trachea and the left main bronchus and reimplantation of intermediate bronchus into the right wall of the trachea proximal to the previous tracheobronchial anastomosis. Results. After a complex tracheo-bronchial resection several “non-surgical” early and delayed complications occured including acute respiratory distress syndrome, non-coronary myocardial infarction type II, thromboembolism of small branches of the pulmonary artery, pneumonia in the lower lobe of the left lung and osteomyelitis of the anterior segment of the 4th rib and perichondritis of the right 4th and 5th rib cartilages after adjuvant chemotherapy. We also demonstrate the methods used to treat complications in order to achieve good mid-term surgical results. Conclusion. Complicated central NSCLC is challenging both for surgical and non-surgical treatment. In carefully selected patients with complicated central NSCLC of the right upper lobe bronchus spreading to the main bronchus and trachea, radical organ-preserving surgery can be performed. Modern advances in thoracic surgery and аnaesthesiology, as well as the collaboration of doctors of various specialties in a multidisciplinary hospital, have made it possible to achieve good oncological and functional results 1.5 years after surgery.