Axillary Dissection with Lobectomy and Chest Wall Resection for Locally Advanced Primary Lung Cancer

Abstract

INTRODUCTION: Lung cancer with chest wall (CW) involvement can develop metastases directly to the ipsilateral axillary lymph node (ALN) via lymphatic flow of the CW. Such metastatic ALNs should be evaluated as locoregional metastases, and multimodal treatment of patients with stage III lung cancer including surgery may be utilized.

CASE PRESENTATION: A 59-year-old man presented with a chief complaint of back pain and was diagnosed as having primary lung adenocarcinoma of the right upper lobe with CW involvement and an ipsilateral ALN metastasis (cT3N0M1b: IVA, 8th edition of the tumor, node, metastasis). We found no mediastinal lymph node (MLN) metastases, so we believed that the metastatic ALN involved metastasis directly from the primary lesion via lymphatic flow of the CW. Therefore, radical surgery after neoadjuvant chemoradiotherapy was chosen as the treatment. During the operation, we performed a right upper lobectomy combined with resection of the involved CW through a posterolateral incision. The right upper limb was then raised, and the scapula was displaced backward, which allowed us to dissect the right ALN.

CONCLUSIONS: Because complete resection can be achieved through intraoperative repositioning of the upper limb, surgical treatment may be utilized for patients with locally advanced lung cancer who have CW involvement and ipsilateral ALN metastasis when the ipsilateral ALN metastasis is believed to have developed from the involved CW rather than from the MLN.