Sleeve Resection of the Right Upper Lobe for Tracheobronchial Metastasis of Hepatocellular Carcinoma With Superior Vena Cava Involvement: A Case Report and Literature Review.

BACKGROUND Hepatocellular carcinoma (HCC) most commonly metastasizes to the lungs, but endobronchial metastasis is an exceedingly rare manifestation associated with a poor prognosis. Surgical resection is seldom considered, with only 2 previously reported cases. This case is presented to highlight the diagnostic challenges of endobronchial metastasis and to report the novel use of an anatomic lung-preserving sleeve resection for definitive treatment, an approach not previously described for this condition. CASE REPORT A 62-year-old man with a history of hepatitis B virus infection and prior right hepatectomy for HCC (pT2N0M0, CNLC Ib) presented with a 5-month history of hemoptysis 43 months after the initial liver surgery. Chest computed tomography (CT) and positron emission tomography (PET)-CT identified a right hilar mass. Two preoperative bronchoscopies with immunohistochemical staining (TTF-1, Napsin A, GPC3, Arg-1) were inconclusive, suggesting a poorly differentiated non-small cell carcinoma. Following disease progression on 3 cycles of neoadjuvant chemoimmunotherapy, the patient proceeded to multidisciplinary team-recommended surgery 4 weeks after the final cycle. The patient successfully underwent a uniportal video-assisted thoracoscopic surgery, during which a right upper lobe sleeve resection was performed, accompanied by resection and repair of the superior vena cava wall. Final histopathology confirmed metastatic HCC. The patient's postoperative recovery was uneventful, with complete resolution of symptoms, and no recurrence was observed during the 3-month postoperative follow-up. CONCLUSIONS This case underscores that endobronchial metastasis from HCC can pose a significant diagnostic dilemma, often requiring surgical resection for definitive diagnosis. It demonstrates that sleeve resection is a technically feasible and oncologically sound option for solitary endobronchial metastasis, achieving complete tumor removal while preserving lung function. This approach should be considered in carefully selected patients with controlled primary disease and good status. The decision-making process emphasizes the critical role of a multidisciplinary team in managing complex metastatic HCC.