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Staged Robotic-assisted Thoracoscopic Enbloc Resection Of Lung Adenocarcinoma With Extensive Vertebral And Chest Wall Invasion
Cynthia M. Xu, MD, Raj K. Thakrar, MD, Haley Leesley, MD, Hana Ajouz, MD, Ziya Gokaslan, MD, Abbas E. Abbas, MD.
Rhode Island Hospital, Providence, RI, USA.
BACKGROUND: Surgery for the resection of lung cancer with vertebral invasion is a highly-invasive procedure with significant operative morbidity, requiring open thoracotomy and potential for incomplete resection. At our institution, we have developed a protocol for a staged approach that includes posterior vertebrectomy followed by enbloc resection through a robotic thoracoscopic technique.
METHODS: A 51-year-old female with history of tobacco use was found to have biopsy-proven adenocarcinoma of the left upper lobe extending into the spinal column at T3-6 and the costovertebral junctions. She had neoadjuvant therapy with partial response. She then underwent a procedure by Neurosurgery to separate the tumor from the spinal cord and spinal column. Two days later, she underwent completion resection of the upper lobe en bloc with the vertebral column and chest wall through a robotic-assisted thoracoscopic approach.
RESULTS: She went to the stepdown unit post-operatively with no neurologic deficits. On post-operative day 2, there was radiographic concern for lower lobe malperfusion requiring robotic-assisted thoracoscopic completion pneumonectomy. Afterwards, she had an uneventful recovery.
CONCLUSIONS: This staged approach to the resection of lung cancer with extensive vertebral and chest wall invasion may reduce the morbidity and ensure complete surgical resection for this disease.
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