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A 69-year-old female smoker (82 pack years) was incidentally diagnosed with a left lung tumor. Imaging revealed an 18×18×10 mm lower-lobe nodule and a 24×30 mm hypermetabolic interbronchial lymph node infiltrating the upper lobe parenchyma. Positron emission tomography-computed tomography (PET-CT) showed intense uptake in both lesions (maximum standardized uptake value [SUVmax] 13.8 and 21.4).
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS‑TBNA) of the 11L lymph node confirmed metastatic adenocarcinoma (programmed cell death ligand 1 [PD‑L1] 1 percent).
After three cycles of neoadjuvant chemo‑immunotherapy (carboplatin + pemetrexed + nivolumab), radiological findings remained stable. The multidisciplinary team recommended surgical resection. Pulmonary and cardiopulmonary testing demonstrated adequate functional reserve for pneumonectomy.
Methods
A left video-assisted thoracoscopic surgery (VATS) pneumonectomy was performed using a three‑port approach.
Results
The intraoperative and postoperative courses were uneventful. Final pathology confirmed metastatic adenocarcinoma consistent with preoperative EBUS findings.
Conclusion
This case demonstrates the feasibility and safety of a left VATS pneumonectomy in selected patients. The video highlights key technical steps, including vascular control, bronchial mobilization, and strategic port placement, offering valuable insights for surgeons performing advanced VATS resections.
References
- Luo J et al. Surgical Outcomes of Video‑Assisted versus Open Pneumonectomy for Lung Cancer: A Real‑World Study. Cancers. 2022;14:5683.
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