Abstract
A 65-year-old man was refered to our hospital with the diagnosis of lung squamous cell carcinoma of the left upper lobe invading the apical chest wall and mediastinum. His chief complaints were hoarseness and left shoulder pain. Chest CT revealed the tumor of the left upper lobe, invading cartilage of the 1st rib, mediastinal fat, and left brachiocephalic vein, with a size of 6.2×3.9 cm. He was preoperatively treated with four cycles of cisplatin and TS-1 concurrently with 66 Gy of radiation under the diagnosis of superior sulcus tumor (SST). Staging after induction chemoradiotherapy revealed partial regression of the tumor. He was scheduled for surgical resection. Firstly, as the pulmonary hilum was outside the radiation field, we divided the lung-invading part of the tumor to the chest wall, and left upper lobectomy and mediastinal lymph node dissection were performed by video-assisted thoracoscopic surgery (VATS) in the lateral decubitus position. Secondly, resections of the tumor and cartilage of the 1st rib, mediastinal fat, internal thoracic artery, vagal nerve, and phrenic nerve were performed by a transmanubrial approach (TMA) in a supine position. The operative time was 173 minutes for VATS and 168 minutes for TMA, and blood loss was 70 mL. Pathological findings revealed no residual carcinoma, but positive results for ypT0N0M0 and Ef3. Although there are few reports on minimaly invasive surgery for SST after induction chemoradiotherapy, this TMA followed by VATS might be a useful approach from the perspective of minimaly invasive surgery.
