Video-assisted thoracoscopic surgery: pneumonectomy for synchronous primary lung malignancies

Habiba Hashimi, David T. Cooke, Sarah K. Holmes, Lisa M. Brown, Elizabeth A. David


Background: Although video-assisted thoracoscopic surgery (VATS) initially demonstrated slow adoption amongst thoracic surgeons, VATS is now widely accepted and the techniques are associated with equivalent nodal dissection and, improved perioperative morbidity and, in some cases, superior perioperative survival compared to thoracotomy. Using a video-assisted, minimal access technique that requires marginal or no rib spreading, VATS provides improved postoperative pain and decreased time-to-recovery after surgery. However, complex resective cases, such as pneumonectomy, are not commonly accomplished minimally invasively. We share the surgical technique for VATS pneumonectomy based on our experience.
Methods: A 71-year-old patient underwent VATS pneumonectomy for synchronous, ipsilateral primary non-small cell lung cancer (NSCLC).
Results: Our patient had no perioperative complications and was discharged to home on postoperative day 4. The patient’s pain was managed with oral analgesics. Greater than ten lymph nodes were examined, all margins were negative for residual tumor. The patient did not require adjuvant radiation or chemotherapy.
Conclusions: VATS pneumonectomy is a safe and effective procedure that provides many clinical benefits to the patient. Our results suggest that clinicians should consider VATS pneumonectomy for primary treatment of patients with synchronous primary lung cancers when appropriate.