73 - Videositzung
16. Mai 2019, 17:30 - 19:00, Bellavista 2, 6. OG
Uniportal thoracoscopic partial left lower sleeve lobectomy for centrally located Non-Small Cell Lung Cancer
L. F. Azenha, R. A. Schmid, J. A. Lutz, Presenter: L. F. Azenha (Bern)
Sleeve lobectomies are frequently performed to treat patients with Non-Small Cell Lung Cancer (NSCLC) located near or invading the interlobar carina, who accordingly to their functional lung tests, comorbidities or general health status would not qualify for a pneumonectomy. While routinely performed in open surgery they remain a technical challenge in thoracoscopic surgery, even though this subgroup of patients would benefit the most from a minimal invasive approach.
In March 2018 we performed a left lower lobectomy in a 82 year old patient with squamous cell carcinoma of the left lower lobe cT2a cN0 cM0, Stage IB using an uniportal thoracoscopic approach. To rule out a microscopic invasion of the surgical margin we ordered a frozen section of the bronchus stump, which showed a R1 status on the stapling line. Completion by pneumonectomy was not feasible due to a VO2max of 16.2 ml/kg/min. We decided to perform a bronchoplasty of the left upper lobe using the uniportal approach.
A second frozen section still showed a remaining microscopic invasion of the surgical margin. The patient would not tolerate a more extensive resection, thus we decided to accept the R1-status of resection. The chest tube could be removed on postoperative day 2. Antibiotic treatment was given in the further hospital course because of contralateral pneumonia and the patient was discharged on postoperative day 10. Final histology showed an NSCLC pT3 pN1 (1/19) R1, stage IIIA, and an adjuvant chemotherapy was administered following discussion at the tumorboard. The patient showed no sign of local recurrence at 6 months follow up.
Sleeve lobectomies can be performed using uniportal thoracoscopy and offer the combined advantages of minimal invasive approach and parenchymal sparing, especially for borderline patients. Training in these advanced surgical skills allows to offer potential curative resections to more patients with centrally located tumors.