Abstract
We performed combination surgery with right superior lobectomy of the lung under thoracotomy and trans-cervical tumorectomy for a relative large thyroid tumor for a patient with lung cancer.
The patient was a 70-year-old man with the chief complaint of cervical pressure. CT scan revealed lung cancer and thyroid tumor, and it was clarified that his complaint was caused by pressure due to a goiter. Therefore, combination surgery with lung lobectomy and thyroid tumorectomy was chosen. The thyroid tumor was able to be removed through the neck in spite of progression forward to the upper mediastinum. At the same time, right superior lung lobectomy, mediastinal lymph node dissection, and 4th-6th rib bone resection under thoracotomy were performed. Tracheostomy was not performed. Complications such as swallowing disorder or phonation disturbance did not occur postoperatively. According to the pathological diagnosis, the lung cancer was squamous cell carcinoma and the thyroid tumor was adenomatous goiter.
Usually, combination surgery of the neck and thorax, especially tracheostomy, is not performed because of the high ratio of complications such as mediastinitis or thoracic emphysema.
In this case, cervical pressure was applied to the goiter and the inferior edge of the goiter was related to the lung cancer. These were major problems, because the inferior edge of the goiter was involved in the area of lung lobectomy, and it was feared that the goiter could not be removed by the trans-cervical approach after lobectomy, due to postoperative adhesion. For this reason, we decided to perform combination surgery, and obtained good results. It is thought that the choice of long-term intubation to regulate the airway, instead of tracheostomy, prevented complications this time. On the other hand, the goiter was able to be removed by a trans-cervical approach only because the inferior edge of the goiter was located at the superior line of the aorta.
