Thoracoscopic lobectomy after bilateral lung transplantation

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Pulmonary Medicine

Background:

• Lung transplantation is a life-saving procedure for end-stage lung disease.
• Recurrence of primary lung cancer or development of a new primary lung cancer can occur post-transplant.
• Managing new thoracic malignancies in lung transplant recipients presents unique challenges due to immunosuppression and prior surgical history.

Observation:

• A 61-year-old female, 6 years post-bilateral lung transplantation, presented with a 19-mm hypermetabolic coin lesion in the right upper lobe.
• Imaging revealed no locoregional or distant metastatic disease.
• The patient underwent a minimally invasive approach using video-assisted thoracic surgery (VATS).

Findings:

• Initial frozen section diagnosed large-cell carcinoma.
• A subsequent VATS right upper lobectomy with mediastinal lymph node dissection was performed.
• Final pathology confirmed pT1bN0M0 non-small-cell lung cancer, with the patient alive and disease-free one year post-surgery.

Implications:

• This case demonstrates the feasibility and safety of performing VATS anatomical lung resection in lung transplant recipients.
• Minimally invasive techniques like VATS may be a viable option for managing early-stage lung cancer in this complex patient population.
• Successful oncologic resection post-transplant offers potential for improved long-term outcomes.