Metastatic lung cancer is common in cases with double cancers, including those with tongue cancer. A 73-year-old man (height, 158.8 cm ; weight, 51.9 kg) was scheduled to undergo the simultaneous resection of a tongue tumor and a left upper lobectomy.
Anesthesia was induced using remifentanil, propofol, and rocuronium. The tongue tumor was resected during nasal intubation. After the excision of the tongue tumor, a bronchial blocker was inserted via the nasal endotracheal tube. Then, a left upper lobectomy was performed. The arterial blood gases after insertion of the bronchial blocker were within the normal levels : FiO2, 0.6 ; pH 7.35 ; PCO2, 42 mmHg ; PO2, 315 mmHg ; and BE, −2.1 mmol/l. After surgery, the patient's oxygenation was good, and no respiratory complications occurred perioperatively.
Before the insertion of the bronchial blocker through the nasal endotracheal tube, the size, shape and location of the nasal space was confirmed using computerized tomography (CT). We predicted preoperatively that the lumen required for ventilation could be secured and calculated the required tube thickness using the outer and inner diameters of the intubation tube. In the present case, the required inner diameter was greater than 3 mm ; this diameter accounted for the deformation of the intubation tube into an oval shape as a result of compression from the nasal cavity tissue after its insertion into the nasal cavity.
Artificial intelligence analysis of PET-CT and CT images is becoming widespread, and the early detection of distant metastases of oral cancer is expected to increase. The simultaneous resection of oral cancer and pulmonary metastases is indicated for patients who are capable of undergoing a single operation.
