A 72-year-old male with a smoking index of 64 packs of cigarettes per year.
She came to medical evaluation for having had left chest pain associated with non-pleural cough.
He was diagnosed by chest X-ray with a heterogeneous stellar opacity in the left upper lobe of the lung, reason why he came to consultation with obstructive pulmonary surgery (COPD) clinic and functional basis for chronic obstructive pulmonary disease (COPD).
Chest CT showed the presence of a tumor of more than 7 cm in diameter, located in the left upper pulmonary lobe, in the anterosuperior segment, closely related to the diameter and without evidence of associated mediastinal nodules.
Fiberoptic bronchoscopy showed chronic inflammatory alterations without endobronchial lesion.
The cytology of bronchial lavage and brushing were positive for malignant epithelial neoplasia with presumptive diagnosis of adenosquamous carcinoma.
Transthoracic needle aspiration biopsy (BAAF) was performed with tomographic control, which histologically confirmed the neoplasm.
Hepatosplenic, cerebral and bone scintigraphy were negative.
Positron emission tomography (PET-Scan) was also negative.
Clinical staging was IIB (T3, N0, M0).
We propose resection surgery, with possibility of extensive resection including the thoracic wall.
The surgical procedure was performed using ipsilateral left tumor, a 10 cm diameter tumor extending to the chest wall (pleura and intercostal muscles).
We performed en bloc resection, pneumonectomy and removal of fragments of second, third and fourth costal arches; the dimensions of the original defect were approximately 10X15 cm.
Mediastinal lymph node resection was also performed in paratracheal, subcarinal, septal-pulmonary and paraesophageal lymph nodes (16 total lymph nodes).
After resection, reconstruction was performed by placing a polyester mesh and fixing it to the chest wall using simple stitches; we placed it through cutaneous counter-opening and closed the stent by conventional technique.
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The postoperative course was uneventful and there was no evidence of instability of the chest wall, with preservation of lung function and satisfactory aesthetic results.
After 10 months postoperatively, there were no data on tumor activity.
It is worth noting that the patient underwent a respiratory rehabilitation program for 6 weeks before surgery.
