Abstract
BackgroundPulmonary metastasectomy was performed in the early twentieth century and ever since, it has evolved to be one of the main treatment options for certain metastatic malignancies. The advancement of minimally invasive procedures enabled new techniques to minimize morbidity and improve patient quality of care and overall outcome.Cases presentationHerein we present three patients, aged 53, 48, and 27 years, known to have sigmoid, rectal, and non-seminomatous germ cell tumors respectively. All patients were diagnosed to have metastatic lung nodules and underwent laparotomy to excise abdominal tumors followed by trans-diaphragmatic single-port video-assisted thoracoscopic pulmonary metastasectomy. All patients achieved complete surgical tumor excision, and none had pulmonary related complications on follow-up.ConclusionOur prescribed novel trans-diaphragmatic single-port video-assisted thoracoscopic surgery (VATS) technique for synchronous pulmonary metastasectomy and intra-abdominal tumor resection is safe and can achieve complete resection with negative margins.
Highlights
The lungs are the second most frequent site of metastatic growth from extra-thoracic malignancies
A 2stage synchronous or metachronous surgical approach involving the resection of the metastatic pulmonary nodules and the primary malignancy is the mainstay treatment with a 5-year overall survival of 30–55%
In an attempt to reduce the invasiveness of simultaneous intra-abdominal tumor resection and lung metastasectomy, we developed a simple and novel technique to resect synchronous lung lesions via a transdiaphragmatic single port video-assisted thoracoscopic surgery (VATS) approach in patients undergoing intra-abdominal
Summary
Simultaneous transdiaphragmatic resection of lung lesions in patients undergoing intra-abdominal tumor resection is safe. Minimal invasive VATS utilizing a 3 cm single port access through the diaphragm to the chest cavity is a novel approach that can allow a complete R0 pulmonary metastasectomy with no surgical complications and diaphragm function was spared, shown by post-operative functional assessment with sniff test, as seen in our case series. This lowinvasive technique will facilitate aggressive surgical treatment for synchronous intra-abdominal tumor and lung metastases
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