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TOTAL LUNG-SPARING ROBOTIC SLEEVE RESECTION OF A DISTAL LEFT MAINSTEM CARCINOID TUMOR
Gloryanne Gautier Nieves, MD1, Derek K. Afflu, MD2, Catherine Byrd, MD2, Charles T. Bakhos, MD, MBA, MS, FACS2.
1Fox Chase Cancer Center, Philadelphia, PA, USA, 2Temple University Hospital, Philadelphia, PA, USA.
BACKGROUND: To present the use of multimodal determination of resection margins for a distal left mainstem carcinoid tumor abutting the secondary carina.
METHODS/RESULTS: We present a case video of a lung-sparing sleeve resection of a distal left mainstem tumor. Patient is a 60-year-old male with a history of obstructive sleep apnea and no significant past surgical history, found to have a distal left mainstem tumor. The tumor was noted to be abutting the left secondary carina and near-obstructing. Biopsy was consistent with well-differentiated neuroendocrine tumor, favoring typical carcinoid. Given the pathology, tumor size, and tumor location, a robotic lung-sparing approach to sleeve resection was undertaken. Proximal and distal resection margins were determine using multimodal technique (bronchoscopic needle localization). The airway was subsequently reconstructed primarily with excellent results. The patient was discharged from the hospital shortly after his procedure. 3 months following his resection, patient's bronchoscopy shows preservation of airway anatomy with no evidence of stenosis.
CONCLUSIONS: This video demonstrates the effective use of needle localization to obtain margins in an airway mass abutting the secondary carina, sparing the patient from a left pneumonectomy.
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