Video-assisted thoracoscopic surgery for the central bronchogenic carcinoma with invasion of the main bronchus and pulmonary artery: A case report

Abstract

Surgical treatment for central bronchogenic carcinoma with invasion of the main bronchus and pulmonary artery often include bronchial anastomosis and pulmonary angioplasty. As a technique, video-assisted thoracoscopic surgery (VATS) lobectomy has proven to reduce the rate of occurrence of complications, and thereby obtain improved survival rates. In the present case study, its use in treating central bronchogenic carcinoma with invasion of the main bronchus and pulmonary artery is reported. A case study of a 68-year-old man with a history of smoking 15-20 cigarettes per day for 40 years is described, who presented with a cough and hemoptysis. A bronchial sleeve left upper lobectomy and pulmonary angioplasty were performed with complete VATS and routine lymph node dissection. The preoperative diagnosis of squamous cell carcinoma (SCC) of the lung (cT2, N2, M0, stage IIIA) was confirmed as SCC through the postoperative pathological examination, leading to the tumor staging: pT2, N1, M0, stage IIB. These results were obtained without sacrificing the oncological principles of thoracic surgery. It has been demonstrated that VATS may be applied for treating central bronchogenic carcinoma with invasion of the main bronchus and pulmonary artery. However, end-to-end bronchial anastomosis and continuous suture of the pulmonary artery were difficult to perform, and use of the VATS procedure is on a learning curve, which will be informative for surgeons and their assistants.

Keywords: bronchial anastomosis; central bronchogenic carcinoma; pulmonary angioplasty; video-assisted thoracoscopic surgery.

Figure 1.

Preoperative examination of the patient. (A) The chest X-ray demonstrated a shadow of a mass in the left pulmonary hilum. (B) Bronchoscopy revealed a cauliflower-like mass which blocked the distal portion of the left main bronchus. (C) Chest computed tomography demonstrated a well-defined mass located on the left upper lobe bronchus. (D) Chest computed tomography demonstrated that the mass had pulmonary artery invasion.

Figure 2.

Images captured of the VATS bronchial sleeve resection and pulmonary angioplasty. (A) The superior pulmonary vein was resected using a 45-mm white linear stapler. (B) The left pulmonary artery, which partly had tumor invasion, was freed and blocked. (C) The left pulmonary artery was repaired using a continuous prolene suture. (D) The anastomosis between the left main bronchus and left lower lobe bronchus were processed using a prolene suture.

Figure 3.

The postoperative pathology revealed that the result of the microscopic examination was squamous cell carcinoma.