Lung autotransplantation after total lung resection for stage Ⅲ central lung cancer in one patient
Objective To investigate the clinical effect of lung autotransplantation with third carinal and arterial reconstructions after total lung resection in the treatment of one patient with stage Ⅲ central lung cancer.Methods On August 18,2023,a 52-year-old male patient with stage Ⅲ central lung cancer underwent lung autotransplantation after left total lung resection in the First Affiliated Hospital of Zhengzhou University.He was admitted to hospital with the chief complaints of"intermittent cough and sputum for more than 2 months".A tracheoscopy was performed in another hospital one week before admission,with the histopathological results(biopsy of the left hilum of the lung)of high-grade squamous intraepithelial neoplasia(squamous carcinoma in situ).After admission,he received contrast-enhanced chest CT scan,revealing central lung cancer of left lung complicated with atelectasis in the upper lobe of the left lung and consolidation in some lung tissues,as well as compensatory emphysema in the left lung.Lung function examination indicated mixed ventilation disorder with moderate to severe obstruction.Bone scan,head MRI and abdominal CT showed no abnormalities.On the basis of medical history and related examination results,he was diagnosed with central squamous carcinoma of the upper lobe of the left lung,with a clinical stage of T2N2M0.After 4 courses of neoadjuvant treatment with Sindilizumab+albumin-binding paclitaxel+carboplatin,the mass showed no shrinking.A multidisciplinary consultation recommended surgical treatment.Left total lung resection plus lung autotransplantation was proposed since the total lung resection was intolerable because of poor lung function,and sleeve lobectomy had residual tumor because of the large local invasion of the tumor.The whole left lung was removed first,the left lower lung and left pulmonary artery trunk were separated in vitro,and the invaded middle pulmonary artery trunk and part of the left lower lobe bronchus were removed.The left inferior pulmonary artery trunk was reconstructed from autologous pericardium.The dorsal and basal bronchus of the left inferior lobe were pruned and the third carina was reconstructed.The left lower lung with reconstructed third carina and artery was placed into the chest for lung autotransplantation.The intraoperative and postoperative clinical data were recorded.Results The surgery was performed smoothly in 295 min.The blood flow was blocked for 140 min.The bronchial anastomosis and embedding were finished in 35 min.The arterial anastomosis was done in 14 min,and the venous anastomosis was done in 8 min.The intraoperative bleeding was 600 mL.No postoperative complications occurred.The histopathological results showed moderately differentiated squamous cell carcinoma,with no residual tumor in the bronchial stump.The resected lymph nodes were found metastasis,and the histopathological stage was T2aN1M0.On the third day after surgery,chest CT scan showed a good reexpansion of the left lower lung and patency of bronchus.The patient recovered well after surgery,with no restriction on normal life,and was discharged 2 weeks after surgery without further lung function examination.Tracheoscopy and CT angiography of pulmonary artery 1 month after surgery showed no obvious stenosis or thrombosis.The patient was followed up till December 2023,and had kept exercising and recovering.Conclusion For patients with stage Ⅲ central lung cancer with extensive bronchial/pulmonary artery involvement,lung autotransplantation after total lung resection and bronchial and pulmonary artery reconstruction in vitro can preserve functional lung tissue and improve postoperative quality of life,and it is safe and effective.
central lung cancertotal lung resectionlung autotransplantationcarinal reconstructionpulmonary artery
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