Laparoscopic Adrenalectomy (2017) s/p Neoadjuvent Chemotherapy, Left Pneumonectomy and Pulmonary Artery Angioplasty/Mobilization of Tumor Off Aorta on Cardiopulmonary Bypass for Stage 3 (pT4N2) Left Lung Adenocarcinoma

Locally Advanced T4N2 non-small cell lung were noted to have a median progression-free survival of 13 months, median overall survival of 20 months and 71%, 40.3% and 28.2% of patients survived 1,2 and 3 years after diagnosis,... [ view full abstract ]

Locally Advanced T4N2 non-small cell lung were noted to have a median progression-free survival of 13 months, median overall survival of 20 months and 71%, 40.3% and 28.2% of patients survived 1,2 and 3 years after diagnosis, respectively, in a study performed by Arsian et al (1).  A study by Varela et al in Journal of Thoracic Disease deemed operative resection of T4N2 non-small cell cancer “anecdotal and debated considering such categories as unresectable disease with a dismal prognosis of about 7%” (2).  After one tertiary referral center in Los Angeles concluded our patient with stage IIIB (T4N2) lung adenocarcinoma not to be a candidate for treatment, Dr. Robert McKenna performed a left pneumonectomy, pulmonary artery angioplasty and mobilization of tumor off aorta on cardiopulmonary after the tumor responded to neoadjuvent chemotherapy in 2013. Patient did not have evidence of recurrence on chest PET scans every 6 months and prior to conversion to annual surveillance chest, abdomen and pelvis PET scan revealed an adrenal mass that was noted to not to have endocrine activity on subsequent testing. In 2017, a laparoscopic adrenelectomy was performed with  a double lumen tube and one lung ventilation. In this presentation, will discuss cardio-pulmonary bypass, one-lung ventilation and anesthetic consideration for thoracic pneumonectomy and laparoscopic abdominal surgeries.