Rosso Lorenzo, Nosotti Mario, Palleschi Alessandro, Tosi Davide
Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan - Italy.
Tumori. 2016 Nov 11;102(Suppl. 2):56090036-C999-4649-84CE-49B631AF0C70. doi: 10.5301/tj.5000430.
Several techniques have been proposed for the challenging surgical resection of Pancoast tumors. We describe a hybrid approach that combines video-assisted thoracic surgery (VATS) lobectomy and limited Shaw-Paulson thoracotomy.
We report a case of Pancoast tumor in a 57-year-old man, staged as cT3N0M0, that was treated with induction chemoradiotherapy prior to the hybrid surgical approach. After thoracoscopic pleural cavity inspection, an upper right VATS lobectomy by a 3-port standard approach was performed. The chest wall was resected through a limited paravertebral incision, allowing the extraction of the lobe together with the rib segments. The posterior chest wall defect was repaired with a synthetic patch.
The postoperative period was uneventful and the pain never exceed a score of 3 on a visual analogue scale. Pathological examination revealed nonvital tumor cells in the specimen (ypT0N0M0). The patient is disease free at 6 months' follow-up.
With this approach we experienced excellent access to both the apical and hilar structures. Further experiences are needed to validate the role of VATS lobectomy in the multidisciplinary management of posterior Pancoast tumor.
对于具有挑战性的潘科斯特瘤手术切除，已经提出了几种技术。我们描述了一种结合电视辅助胸腔镜手术（VATS）肺叶切除术和有限的肖-保尔森胸廓切开术的混合方法。
我们报告了一例57岁男性的潘科斯特瘤病例，分期为cT3N0M0，在采用混合手术方法之前接受了诱导放化疗。在胸腔镜检查胸腔后，通过三孔标准方法进行了右上VATS肺叶切除术。通过有限的椎旁切口切除胸壁，以便连同肋骨段一起取出肺叶。用合成补片修复胸壁后缺损。
术后过程顺利，疼痛在视觉模拟量表上从未超过3分。病理检查显示标本中肿瘤细胞无活性（ypT0N0M0）。患者在6个月的随访中无疾病。
通过这种方法，我们能够很好地显露肺尖和肺门结构。需要进一步的经验来验证VATS肺叶切除术在后部潘科斯特瘤多学科治疗中的作用。
