Left Pneumonectomy for Non-Small Cell Lung Cancer

Video case: lung cancer is the leading cause of cancer death and the fifth most common cancer diagnosed in Australia. It is responsible for almost one in five cancer deaths in Australia. It was estimated that there would be 3,258 new cases of lung cancer diagnosed in Australian in 2020. Surgery to remove part of the lung (or sometimes a whole lung) is used to treat early stage lung cancer as it is associated with the best chance of cure. Here we present a case of lung cancer involving a part of the left main bronchus (airway of the lung). We removed the entire lung, known as a pneumonectomy procedure, to remove all the known tumour in this patient. Whilst we most commonly perform lung cancer surgery through small incisions and video-assistance, in this case the size and central location of the tumour meant this was not possible. We performed a thoracotomy to get good access to the chest cavity. The patient is a 47 year old man who presents to hospital with shortness of breath. Imaging shows collapse of the left lung. Bronchoscopy reveals tumour occluding the distal left main bronchus. Biopsy confirms non-small cell lung cancer, squamous cell histology. CT-PET shows no evidence of metastatic disease or mediastinal lymph node involvement. Taken for surgery with plans to perform a left pneumonectomy. Following surgery the patient made an uneventful recovery. He was discharged home 7 days after surgery. The pathology results of the resected lung and lymph nodes confirmed a 36mm squamous cell cancer of the lung. In addition, there was a single lymph node adjacent to the tumour within the resected lung specimen that was involved by direct tumour invasion. There was a 1.2mm focus of tumour within the soft-tissue at the bronchial resection margin. Because of these findings he will receive post-operative chemotherapy and radiotherapy to the chest in order to reduce his chances of tumour recurrence in the years ahead.