Video-assisted thoracoscopic left upper lobectomy and bronchoand- angioplasty for a giant central lung cancer complicated with intratumoral abscess: one case report

A 70-year-old male patient with chest pain and high fever was diagnosed as lung squamous carcinoma T4N0M0 in the left upper lobe complicated with intratumoral lung abscess. With no improvement resulted from antibiotic treatment for 4 days, to control his infection and resect his large tumor, he received video-assisted thoracoscopic surgery (VATS) left upper lung lobe resection and broncho-and angioplasty. Two-port technique was employed and the utility port was 10 cm long because the tumor’s diameter (max) was 12 cm. After the first step to divide the tumor from chest wall and mediastinum, the pericardium was opened and dissection was carried out in a direction from anterior to posterior meticulously. The superior pulmonary vein was divided by a stapler and then the upper bronchus cut open. Then the pulmonary artery was blocked and then its branches were cut open. At last, angioplasty and bronchoplasty was completed by sutures. Without any accidental bleeding, the whole operative time was 350 min and bleeding volume 100 mL. After the operation, fever resolved soon and pathologic stage was pT4N2M0. The patient was discharged from the hospital 20 days after the surgery. Generally, large tumor is still challenging in VATS operation and obstructive lung infection or abscess make the operation harder. However, VATS can still be applied in these patients and provide better vision and better chances for recovery without compromise of tumor principle.