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A minimally invasive and safe surgical approach to resect anterior superior sulcus tumors. Int J Surg Case Rep 2020; 68:148-150. [PMID: 32145568 PMCID: PMC7058854 DOI: 10.1016/j.ijscr.2020.02.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/19/2020] [Accepted: 02/24/2020] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Superior sulcus tumors (SSTs) are a wide range of tumors invading a section of the apical chest wall called the thoracic inlet. The unique characteristics of SSTs lie in the anatomy of the region where these tumors occur. For this reason, a surgical approach to treating these tumors is technically demanding, and complete resection may be difficult to accomplish. CASE PRESENTATION A 71-year-old Japanese man presented at our hospital due to left anterior chest pain and an abnormal chest CT scan showing a 40 × 33 × 30-mm tumor located in the left anterior apex of the thoracic inlet. This tumor had invaded the first and second rib and was located near the subclavian vein. There was no significant distant metastasis. Therefore, we performed surgical resection. The surgical procedure included three steps. First, we performed VATS observation via the left thoracic cavity. Second, via the transmanubrial approach, we obtained tumor-free margins of the anterior cervical structures. Third, through VATS in the left lateral decubitus position, we performed left upper lobectomy and mediastinal lymph node dissection. This surgery was successful, with no postoperative complications. DISUCUSSION This surgical approach was effective and safe for treating a superior sulcus tumor located the anterior apex of the thoracic inlet. Next, VATS lobectomy is minimally invasive and safe after the transmanubrial approach for managing anterior superior sulcus tumor. CONCLUSION We experienced a case of locally advanced superior sulcus tumor located at the anterior apex of the thoracic inlet and performed complete resection.
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Kojima K, Yoon H, Sakamoto T, Utsumi T, Sakurai T, Takeuchi N, Takeda M, Kasai T, Atagi S, Matsumura A. Adenocarcinoma with fetal features invading the right superior sulcus treated with neoadjuvant chemoradiotherapy followed by complete video-assisted thoracoscopic right upper lobectomy: a case report. Surg Case Rep 2019; 5:165. [PMID: 31664634 PMCID: PMC6820648 DOI: 10.1186/s40792-019-0737-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 10/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fetal adenocarcinoma of the lung is a rare lung neoplasm that accounts for only 0.5% of all primary lung cancers. Because of its rarity, effective treatments for the management of the tumor are poorly understood. We herein report a case of adenocarcinoma with fetal features of the lung with invasion of the right superior sulcus that was treated with neoadjuvant chemoradiotherapy followed by surgical resection. CASE PRESENTATION A 54-year-old man was referred to a medical institution due to right inner forearm pain. On computed tomography of the chest, a 56-mm mass with invasion of right superior sulcus was discovered. Bronchoscopic biopsy revealed non-small cell lung carcinoma. We performed concurrent chemotherapy (2 cycles of cisplatin and vinorelbine) and thoracic radiation therapy (40 Gy in 20 fractions). As the result of extreme tumor reduction after neoadjuvant chemoradiotherapy, we could perform right upper lobectomy by complete video-assisted thoracoscopic surgery. Since no viable cancer cells were detected from the pathological examination of the resected tissue, the specimen obtained by bronchoscopic biopsy was reexamined by immunohistochemistry. The analysis supported a pathologic diagnosis of adenocarcinoma with fetal features. CONCLUSIONS We experienced a case of adenocarcinoma with fetal features of the lung in which the patient showed a complete response to neoadjuvant chemoradiotherapy. In addition, the tumor invading the right superior sulcus was completely resected by video-assisted thoracoscopic lobectomy. Neoadjuvant chemoradiotherapy followed by surgery may be also an effective treatment for advanced-stage high-grade fetal adenocarcinoma of the lung, similarly to other subtypes of advanced-stage primary lung cancer.
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Affiliation(s)
- Kensuke Kojima
- Department of General Thoracic Surgery, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-cho, Kita-ku, Sakai-shi, Osaka, 591-8555, Japan.
| | - Hyungeun Yoon
- Department of General Thoracic Surgery, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-cho, Kita-ku, Sakai-shi, Osaka, 591-8555, Japan
| | - Tetsuki Sakamoto
- Department of General Thoracic Surgery, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-cho, Kita-ku, Sakai-shi, Osaka, 591-8555, Japan
| | - Tomoki Utsumi
- Department of General Thoracic Surgery, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-cho, Kita-ku, Sakai-shi, Osaka, 591-8555, Japan
| | - Teiko Sakurai
- Department of General Thoracic Surgery, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-cho, Kita-ku, Sakai-shi, Osaka, 591-8555, Japan
| | - Naoko Takeuchi
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-cho, Kita-ku, Sakai-shi, Osaka, 591-8555, Japan
| | - Maiko Takeda
- Department of Pathology, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-cho, Kita-ku, Sakai-shi, Osaka, 591-8555, Japan
| | - Takahiko Kasai
- Department of Pathology, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-cho, Kita-ku, Sakai-shi, Osaka, 591-8555, Japan
| | - Shinji Atagi
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-cho, Kita-ku, Sakai-shi, Osaka, 591-8555, Japan
| | - Akihide Matsumura
- Department of General Thoracic Surgery, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-cho, Kita-ku, Sakai-shi, Osaka, 591-8555, Japan
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Mun M, Nakao M, Matsuura Y, Ichinose J, Nakagawa K, Okumura S. Video-assisted thoracoscopic surgery lobectomy for non-small cell lung cancer. Gen Thorac Cardiovasc Surg 2018; 66:626-631. [DOI: 10.1007/s11748-018-0979-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 07/25/2018] [Indexed: 12/19/2022]
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Dejima H, Kuroda H, Seto K, Sakata S, Arimura T, Mizuno T, Sakakura N, Sakao Y. Two cases of combined thoracoscopy and open chest surgery for locally advanced lung carcinoma. J Thorac Dis 2018; 10:1138-1143. [PMID: 29607193 DOI: 10.21037/jtd.2017.12.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Thoracoscopic surgery is becoming more widely used in thoracic surgery and has an increasingly important role to play. However, its use for locally advanced carcinoma (clinical stage T3-4) remains controversial. We adapted our procedure by combining thoracoscopy and open chest surgery (combination surgery) with the aim of reducing invasiveness while ensuring that the operation is safe and curative. Here we describe our experience. Case 1 was a man in his 60s who underwent induction chemoradiotherapy (cisplatin plus vinorelbine plus 40 Gy radiotherapy) followed by radical surgery for a left apical lung carcinoma with chest wall invasion. Case 2 was a woman in her 70s who repeatedly had pneumonia and who underwent radical surgery for left apical adenocarcinoma that was expected to have strong adhesions to the thoracic wall. A thoracotomy incision may be required in cases of stage T3-4 lung cancer to access the hilar region and dissect the resected tumor and surrounding organs. In such cases, adding thoracoscopy to either one of these procedures may enable the use of a smaller incision in the chest wall. In both cases, complete resection with no residual tumor or complications was achieved, with the patients being discharged 3-8 days postoperatively. Cases 1 and 2 both remain recurrence free after 1.5 and 3 years, respectively). This suggests that having a thorough understanding of the features of both thoracoscopic and open chest surgery and integrating the two may enable surgery to be safely and less invasively performed while ensuring a curative effect.
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Affiliation(s)
- Hitoshi Dejima
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Hiroaki Kuroda
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Katsutoshi Seto
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Shozo Sakata
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Takaaki Arimura
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Tetsuya Mizuno
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Noriaki Sakakura
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yukinori Sakao
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
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Turner SR, Latif MJ, Park BJ. Robotic assisted VATS lobectomy for loco-regionally advanced non-small cell lung cancer. VIDEO-ASSISTED THORACIC SURGERY 2017; 2. [PMID: 30198013 DOI: 10.21037/vats.2017.02.03] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Despite lung cancer screening programs and efforts at early detection, patients with non-small cell lung cancer continue to present with loco-regionally advanced disease. In particular, patients with positive mediastinal lymph nodes (N1/2, stage II/IIIA) present a challenge to the thoracic surgeon. The thorough lymphadenectomy required by these patients can be difficult to perform with standard VATS approaches. In addition, hilar fibrosis may result from the neoadjuvant therapy these patients generally receive, which complicates dissection of the vascular and bronchial structures. The robotic approach offers benefits that can help to address these challenges. While not ideal for the surgeon just learning robotic surgery, in experienced hands this is an effective tool to deal with loco-regionally advanced lung cancer safely and with optimal oncologic efficacy.
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Affiliation(s)
- Simon R Turner
- Thoracic Surgery Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | - M Jawad Latif
- Thoracic Surgery Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Bernard J Park
- Thoracic Surgery Service, Memorial Sloan Kettering Cancer Center, New York, USA
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