A lobectomy alternative in lung cancer with inflammatory lymph node infiltration: a case report

Background: Lobectomy may be a challenging treatment option in lung cancer with inflammatory lymph node infiltration. Moreover, the en-masse lobectomy technique, which involves the simultaneous ligation or stapling of pulmonary vessels and bronchi at the hilar area, is controversial. Case presentation: We report the case of a 75-year-old woman who presented with lung cancer and lymph node infiltration from the posterior ascending pulmonary artery (A2) to the superior pulmonary artery (A6). A nodule was observed in her right upper lobe on chest computed tomography while treating her for a myocardial infarction three months prior; hence, a radical lobectomy was planned. Her main pulmonary artery could be constricted with surgical tape, but this was not possible in the peripheral pulmonary artery of the ascending A2 due to widespread lymph node infiltration. Intraoperative frozen sections confirmed the absence of metastases in the hilar lymph nodes. Pulmonary angioplasty was aborted because the cardiac function had not fully recovered from the previous procedure. The ascending A2 and upper lobe bronchus were collectively treated using an auto-stapler. Two months postoperatively, computed tomography showed no pulmonary artery aneurysm. Conclusions: : This report highlights that the en-masse technique is recommended as an alternative for A2 treatment during lobectomy in cases with inflammatory lymph node infiltration. Surgeons should not hesitate to switch to thoracotomy to avoid fatal intraoperative complications.