Transmanubrial approach with thoracoscopic surgery for bilateral lung cancer: a case report

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Abstract: The transmanubrial approach (TMA) combined with video-assisted thoracoscopic surgery (VATS) is considered to be useful for the resection of anterior superior sulcus tumors (SST). Herein, we report the case of a 68-year-old asymptomatic male patient with a right anterior superior sulcus tumor adjacent to the right subclavian vessels and a left lung apex tumor on the bulla wall. We successfully performed complete resection of the bilateral lung apex high-grade tumors using the TMA combined with VATS with only one postural change. First, the surgery commenced with video-assisted thoracoscopic observation of the right tumor with the patient in the supine position, and the tumor was removed from the safety of major vessels using the TMA combined with VATS. Then, the operating table was tilted with the left side up and the ports were located in front of the normal position and we performed partial resection of the left upper portion of the lung using VATS. Finally, video-assisted thoracoscopic right upper lobectomy was performed with the patient in the left lateral position. Pathologically, the right lung tumor was a pleomorphic carcinoma, and the left lung tumor was a large cell carcinoma. Despite the high severity of the tumor (high-grade double primary lung carcinoma), the patient remains healthy without recurrence 7 years post-surgery and is able to work and independently manage everyday activities. This case shows that our surgical approach to bilateral apex tumors is a sufficiently effective and safe option for patients with bilateral lung cancer.

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