Transcervical wedge resection after transcervical extended mediastinal lymphadenectomy

Transcervical extended mediastinal lymphadenectomy (TEMLA) has been shown to be feasible and safe. This approach may be underrecognized for providing excellent access to the pleural space. We present a 60-year-old woman who had a clinical stage T2b N0 M0 adenocarcinoma of her right lower lobe and several ground glass opacities throughout her upper lobes bilaterally. She underwent a TEMLA to confirm absence of lymph node involvement in her mediastinum. During the same anesthetic setting, a transpleural right upper lobe wedge resection via the cervical approach was performed as an extension of her TEMLA. The pathology from this wedge resection demonstrated atypical adenomatous hyperplasia. Ultimately, she underwent a thoracoscopic right lower lobectomy that confirmed that she had a pathologic T2b N0 M0 (5.0 × 4.0 × 3.0 cm) adenocarcinoma. There were no perioperative adverse events with either operation. Transcervical extended mediastinal lymphadenectomy and transcervical lung resections may be performed safely during the same anesthetic setting.