Autotransplantation for central non-small-cell lung cancer in a patient with poor pulmonary function.

Lung resection is the standard therapy for non-small-cell lung cancer confined to the lung. The extent of pulmonary resection is dictated by the location and extent of the tumor and the patient's physiologic ability to tolerate resection. We present the case of a patient who had a large non-small-cell tumor of the lung that involved the right main stem bronchus and the adjacent pulmonary artery; poor pulmonary function precluded a pneumonectomy. Right upper and middle sleeve bilobectomy resection was performed, but reconstruction was not possible due to tethering by the intact lower lobe vein. Therefore, the remaining lower lobe was removed, and the lower lobe vein was divided and reimplanted into the upper lobe pulmonary venous stump. Cephalad advancement and autotransplantation of the lower lobe were then accomplished. These procedures allowed enough mobilization for direct bronchial and arterial reconstruction.