Bilateral pulmonary metastasectomy through right thoracotomy

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Pulmonary Medicine

Background:

• Bilateral pulmonary metastases often necessitate staged thoracotomies for complete resection.
• Surgical removal of lung metastases aims to improve patient outcomes and survival.
• Previous surgical history can influence treatment strategies for recurrent disease.

Observation:

• A 40-year-old male with rectal adenocarcinoma and prior left pulmonary metastasectomy presented with new bilateral lung metastases.
• The patient's metastatic disease distribution allowed for resection of lesions in the right upper lobe, right middle lobe, and left upper lobe.
• A single right thoracotomy approach was utilized, with the left upper lobe accessed anterior to the ascending aorta.

Findings:

• Successful bilateral pulmonary metastasectomy was achieved through a single right thoracotomy.
• This demonstrates the potential for a less invasive surgical approach in select cases.
• The technique involved careful planning to access contralateral lung deposits via the initial incision.

Implications:

• This approach may reduce surgical morbidity and recovery time compared to staged bilateral thoracotomies.
• It offers a potentially more efficient treatment option for patients with specific patterns of bilateral lung metastases.
• Further research could explore the oncologic outcomes and patient selection criteria for single-incision bilateral pulmonary metastasectomy.