Two-stage minimally invasive pulmonary resections with intraoperative localization technique for bilateral multiple primary lung cancers: A case report.

Publisher: Wiley Publishing Asia Pty Ltd Country of Publication: Singapore NLM ID: 101531441 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1759-7714 (Electronic) Linking ISSN: 17597706 NLM ISO Abbreviation: Thorac Cancer Subsets: MEDLINE

Publication: November 2012- : Singapore : Tianjin : Wiley Publishing Asia Pty Ltd ; Tianjin Lung Cancer Institute
Original Publication: Richmond, Vic. : Tianjin : Blackwell Pub. Asia Pty Ltd. ; Tianjin Lung Cancer Institute

Lung Neoplasms*/diagnostic imaging ; Lung Neoplasms*/surgery ; Lung Neoplasms*/pathology ; Adenocarcinoma*/pathology ; Neoplasms, Multiple Primary*/surgery ; Solitary Pulmonary Nodule*/pathology; Female ; Humans ; Aged ; Quality of Life ; Pneumonectomy ; Postoperative Complications/surgery ; Retrospective Studies

Multiple primary lung cancers (MPLCs) are becoming more and more common and these patients can benefit from minimally invasive surgery. Here, we report a case of a patient diagnosed with synchronous MPLCs who underwent bilateral thoracoscopic pulmonary resections in a two-stage strategy, and achieved a good surgical outcome and high quality of life. A 66-year-old female was found to have one major ground-glass nodule (GGN) in the right upper lobe and eight minor GGNs in the left upper and lower lobes. The patient underwent right upper lobe resection and systematic mediastinal lymph node dissection via single-utility port thoracoscopic surgery in September 2018. Pathology was lepidic predominant adenocarcinoma pT1bN0M0, IA2. Regular high-resolution computed tomography examination during 36 months after right upper lobectomy showed gradually increasing diameter and solid component of multiple GGNs in left lung. The patient underwent thoracoscopic multiple pulmonary resections using an intraoperative localization technique in a hybrid operating room in October 2021 and all eight nodules in the left lung were resected. Two segmentectomies and four wedge resections were performed, and the pathological results of the eight nodules included four adenocarcinomas, three adenocarcinomas in situ, and one alveolar epithelial hyperplasia. The two operations were successful with no intra- or postoperative 90-day complications. During more than 20 months of follow-up after the second operation, the patient had well recovered pulmonary function and physical status with a Karnofsky performance status score of 90 and no local recurrence or metastasis. A two-stage surgical strategy for synchronous MPLCs is therefore feasible. The surgical strategy, timing of intervention, and extent of pulmonary resection should be individually designed according to the location and characteristics of each nodule. Intraoperative localization of small GGNs is very important to ensure that all nodules are completely and accurately resected during the operation.
(© 2023 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.)

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BJ-2022-185 National High Level Hospital Clinical Research Funding

Keywords: ground-glass nodule; intraoperative localization; multiple primary lung cancers; surgical strategy

Date Created: 20231129 Date Completed: 20240116 Latest Revision: 20240117

20240117

PMC10788464

10.1111/1759-7714.15183

38018514