[A successful removal of T4 lung cancer with its left atrial extension using cardiopulmonary bypass]

A 42-year-old man presented with cough, chest pain and dyspnea. The chest roentgenogram revealed a large mass shadow in the right upper and middle lobes with atelectasis and pleural effusion. Massive polypoid tumor extending into the left atrium was diagnosed by computed tomography and two dimensional echocardiography. In order to prevent sudden death and cardiac failure, surgery was performed. At first, the polypoid tumor in the left atrium was removed with a partial resection of the left atrial wall under cardiac arrest using cardiopulmonary bypass. Then, a right pneumonectomy was performed. Episodes of embolism were not observed during surgery. His postoperative course was almost favorable. The size of the tumor in the right lung was 18 x 15 x 8 cm and the one in the left atrium was 6.5 x 4.5 x 3 cm, respectively. Pathological examination of the resected specimen revealed the evidences of large cell carcinoma extending into the left atrium. Local recurrence with S9 metastasis of the left lung were detected 6 months after surgery, and he died 6 months later. It is emphasized that the extended surgery using cardiopulmonary bypass was useful for both prevention of embolism and improvement of quality of life.