Robotic-Assisted Salvage Completion Left Pneumonectomy After Chemo-Immunotherapy and SBRT

A 64-year-old woman with a history of Stage IIIA adenocarcinoma of the left lower lobe underwent robotic-assisted left lower lobectomy and mediastinal node dissection in 2016, followed by adjuvant chemotherapy. Subsequently, she was found to have brain metastasis requiring SBRT and mediastinal adenopathy that was biopsy-proven recurrence in 2019. At that time, she started on carboplatin, pemetrexed and pembrolizumab. 
 
The following year, she experienced recurrence in the left upper lobe, which was treated with SBRT of 50 Gy in five fractions in 2020. In 2023, she was found to have interval increase in the size and FDG activity of this left upper lobe mass. After discussion with a multidisciplinary tumor board, the recommendation was to consider proceeding with a salvage completion left pneumonectomy. 
 
The authors present her case of a robotic-assisted salvage completion left pneumonectomy with an intercostal muscle flap. Her postoperative course was uncomplicated, and she was discharged home on postoperative day two. This case suggests that minimally invasive salvage lung resections, performed safely with low morbidity and mortality, may be a viable option for managing recalcitrant lung cancer. 

References

1. Dickhoff C, Unal S, Heineman DJ, Winkelman JA, Braun J, Bahce I, van Dorp M, Senan S, Dahele M. Feasibility of salvage resection following locoregional failure after chemoradiotherapy and consolidation durvalumab for unresectable stage III non-small cell lung cancer. Lung Cancer. 2023 Aug;182:107294. doi: 10.1016/j.lungcan.2023.107294. Epub 2023 Jul 11. PMID: 37442060.

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