Aortic endostent followed by extended pneumonectomy for T4 lung cancer

Pulmonary and aortic en bloc resection may be performed with cardiopulmonary bypass support, but is associated with high surgical morbidity and mortality. A 59-year-old man with left lower lobe cancer invading the aorta was considered to be unsuitable for such an extended operation because of previous myocardial infarction, coronary bypass grafts, and subsequent multiple coronary artery stenting. Pneumonectomy with en bloc resection of aortic adventitia and media was accomplished after thoracic aorta endovascular stent graft placement. The aortic defect was reinforced with an extrathoracic muscle flap. The postoperative course was uneventful, and the patient was faring well at the 23-month follow-up. An endovascular stent may be an alternative in selected patients with aortic involvement, avoiding the need for cardiopulmonary bypass.