Lobectomy with Systemic Lymphadenectomy and Superior Vena Cava Reconstruction via Modified Hemi-clamshell Approach

Han-yu Deng, Qinghua Zhou

west china hospital, sichuan university, chengdu, China

Date, time and location: 2018.05.26 08:30, Congress Hall, 2F–C

Abstract

Lung cancer invading superior vena cava (SVC) requiring SVC reconstruction is generally deemed unresectable. However, previous evidence has proved that such patients could benefit from surgery if radical resection is achieved. Here we developed a novel modified two-step hemi-clamshell approach combining median sternotomy and lateral thoracotomy, via which radical lobectomy with lymphadenectomy of bilateral mediastinal lymph nodes and SVC reconstruction was successfully achieved. Here we reported a case applying our novel method. A 42-year-old man presented with severe cough and facial edema was admitted into our department. His computed temography (CT) revealed a mass in the upper right lung lobe with enlarged ipsilateral and contralateral mediastinal lymph nodes invading the superior vena cava (SVC) and brachiocephalic veins. This patient underwent radical resection of the mass with lobectomy and systemic lymphadenectomy with reconstruction of SVC via modified two-step hemi-clamshell approach-combination of median sternotomy and lateral thoracotomy for easy and enough access to contralateral mediastinum and ipsilateral posterior mediastinum. At first, the patient was placed at supine position and underwent median sternotomy, via which the left brachiocephalic vein was reconnected to the right atrium with GORE-TEX®vascular graft (W.L. Gore and Associates, AZ, USA) and dissection of the contralateral mediastinal lymph nodes was achieved. Then the patient was placed at left lateral decubitus position and underwent right thoracotomy, via which radical lobectomy and systemic dissection of iplateral lymph nodes was achieved and the right brachiocephalic vein was reconnected to the right atrium with GORE-TEX® vascular graft after resection of SVC. Postoperatively, the mass was pathologically and immunohistochemically diagnosed as lung adenocarcinoma (pT4N3M0, IIIC). The postoperative course was uneventful, and the patient was discharged at postoperative day 10.Our initial experience proved that this novel modified two-step hemi-clamshell approach was safe and feasible.