VATS Lobectomy with Sleeve Bronchoplasty and Arterioplasty

A 36-year-old woman was diagnosed with a left lung mass, which was incidentally detected during a routine x-ray examination. She had undergone right radical mastectomy with axillary clearance for carcinoma in July 2014. A thorax CT scan showed a large left upper lobe lung mass, with another nodule in the same lobe. A PET scan showed avid SUV take up in the left upper lobe primary mass, with multiple satellite lung nodules in the same lobe and ipsilateral mediastinal nodes. EBUS-guided biopsy revealed mucinous adenocarcinoma of the lung. In view of the Stage IIIA disease, she underwent two cycles of neoadjuvant chemotherapy with Cisplatin/Pemetrexed. Downstaging of the tumor was achieved. A repeat CT scan revealed a slightly smaller left upper lobe mass in continuity with the hilum. The mass abutted the mediastinum and narrowed the left upper lobe bronchus, with no mediastinal lymphadenopathy. In view of these findings, it was decided to proceed with definitive surgery.

The patient underwent left upper lobectomy with wedge resection of the pulmonary artery, sleeve bronchoplasty, and mediastinal lymph node dissection. She was stable postoperatively. The chest drain was removed on the third postoperative day, and she was discharged on the same day.

Histopathological report: Moderately differentiated adenocarcinoma of the lung, 6.0 cm in largest dimension. Several additional tumor nodules present within the same lobe. Three intralobar lymph nodes involved by malignancy, negative bronchial margins (Stage IIIA/T3N1M0). The patient is due to receive adjuvant chemotherapy.