Video-assisted thoracoscopic right upper sleeve lobectomy after neoadjuvant chemotherapy for central non-small cell lung cancer

Abstract

Sleeve lobectomy is an uncommon thoracic surgical procedure. Nonetheless, it is an accepted treatment option to avoid pneumonectomy in patients with centrally, locally advanced non-small cell lung cancer. In appropriately selected patients, the outcome of sleeve lobectomy is equivalent to pneumonectomy with comparable recurrence rates, with less perioperative morbidity, improved functional outcomes, and superior quality of life post-surgery. According to the National Comprehensive Cancer Network (NCCN)or Chinese Society of Clinical Oncology (CSCO) guidelines, neoadjuvant chemotherapy has become the standard treatment regimen in patients with stage N2 non-small cell lung cancer, despite the high risk of associated complications, due to its proven efficacy in improving prognosis in these patients. Here we report a case of a central squamous carcinoma in the upper lobe of the right lung. Bronchoscopy revealed rough and uplifted mucosa in the right upper bronchus and a narrow lumen. The patient was diagnosed with squamous carcinoma of the right upper lobe with subcarinal lymph node metastasis, and no distant metastasis (clinical stage cT4N2M0, IIIB). The Multi-Disciplinary Treatment (MDT)team recommended 2 cycles of neoadjuvant chemotherapy. Although the size of the tumor had reduced significantly after the second cycle, as observed on the CT images, it was still close to orifice of the right upper bronchus. So our surgical team performed a right upper sleeve lobectomy with 3-port thoracoscope. The patient recovered very well after the procedure. Our first experience of bronchial reconstruction after neoadjuvant chemotherapy showed no increased morbidity and mortality, making it a technically safe and feasible approach.