Completion pneumonectomy and combined resection of esophageal and thoracic aortic walls with simultaneous thoracic aortic endografting: A case report.

INTRODUCTION: Completion pneumonectomy and combined resection of the thoracic aortic wall with thoracic aortic endografting are high-risk procedures. The combination of completion pneumonectomy with thoracic aortic wall resection and endografting is exceptionally rare.

CASE PRESENTATION: A 52-year-old man underwent left lower lobectomy and mediastinal lymph node dissection for left lung cancer. Pathological examination confirmed stage IB adenocarcinoma. Three years postoperatively, chest computed tomography revealed a nodule at the left pulmonary hilum and an enlarged subcarinal lymph node. Positron emission tomography showed high uptake in these areas, consistent with local recurrence of lung cancer. Definitive chemoradiotherapy was administered; however, positron emission tomography revealed persistent uptake in the reduced nodules. Salvage surgery was performed for the residual tumor. The procedure included completion pneumonectomy and combined resection of the esophageal muscular wall and thoracic aortic wall, with simultaneous thoracic aortic endografting. The tumor invaded the descending aorta and esophagus. The left upper lobe, resected aortic wall, and esophageal muscular wall were removed en bloc. Postoperative pathology confirmed recurrent adenocarcinoma with invasion into the aortic and esophageal walls. The postoperative course was uneventful, and the patient was discharged on postoperative day 13. At 6 months postoperatively, he had distant metastasis in the meninges, which was treated with radiotherapy. One year after surgery, he was alive with neither local recurrence nor stent graft-related complications.

CONCLUSIONS: One-stage surgery involving combined resection of the lung cancer, esophageal muscular wall, and thoracic aortic wall with simultaneous thoracic aortic endografting is acceptable in highly selected patients.