P1.08-051 VATS Lobectomy Combined with Limited Thoracotomy for Treatment of Superior Sulcus Tumors

Abstract

Despite the increasing of VATS procedures even for locally advanced NSCLC, Pancoast tumors have been rarely approached with VATS combined with chest wall resection. This report describes a hybrid surgical technique to approach “en block” chest resection and pulmonary lobectomy for superior sulcus tumors. We present two cases of patients referred to our Institution. A female patient affected by right anterior Pancoast tumor surgically staged as cT4N0M0 for suspected anonymous vein invasion, underwent induction therapy with four cycles of cisplatin and Pemetrexed plus 60 Gy irradiation, with satisfactory tumor reduction. The surgical operation comprised an initial VATS approach to the hilar structures followed by a limited C-shaped anterior contra-incision; finally, the right upper lobe “en block” with the anterior part of the first and second rib was removed. The second case is a 57-year-old man, affected by a cT3N0M0 posterior Pancoast tumor, treated with induction chemoradiotherapy prior to the hybrid surgical approach. After thoracoscopic pleural cavity inspection, an upper right VATS lobectomy by a 3-port standard approach was performed. The chest wall was resected through a limited paravertebral incision, allowing the extraction of the lobe together with the rib segments. The posterior chest wall defect was repaired with a synthetic patch. The postoperative period was uneventful in both cases, and the pain never exceed a score of 4 on a visual analogue scale. The patients were discharged respectively 9 and 11 days after surgery. Pathological results revealed in both cases nonvital tumor cells in the specimen (ypT0N0M0). The patients are free from disease and post-thoracotomy syndrome at 14 and 18 months' follow-up. VATS combined with thoracotomy approach leads to asses with precision the thoracic wall resection and reduce surgical trauma with very good results in term of postoperative morbidity. We strongly support the “VATS observation first” philosophy, to exclude previously undetected pleural dissemination and to precisely define the tumor location. Further experiences are needed to validate the role of VATS lobectomy in the multidisciplinary management of Pancoast tumor.