Advanced lung cancer invading the left atrium, treated with pneumonectomy combined with left atrium resection under cardiopulmonary bypass. 2010

Junzo Shimizu, and Chikako Ikeda, and Yoshihiko Arano, and Iwao Adachi, and Minoru Morishita, and Shojiro Yamaguchi, and Norihiko Ishikawa, and Go Watanabe, and Hiroshi Minato
Department of Surgery, KKR Hokuriku Hospital, Kanazawa, Ishikawa, Japan.

A 68-year-old man presented with a chief complaint being a cough. Based on a bronchoscopic biopsy, it was diagnosed at a nearby clinic as an advanced left lung cancer, and he was referred to our hospital. Chest computed tomography (CT) scans demonstrated a giant mass of the left lower lobe, 14 × 12 cm in size, which appeared to have invaded the left atrium (LA). The operation was started with double vena cava cannulation via the right internal jugular vein and the right femoral vein as well as arterial cannulation via the right femoral artery. The patient underwent left pneumonectomy combined with LA resection using cardiopulmonary bypass (CPB), without aortic clamping, through left posterolateral thoracotomy under hypothermia (32 °C). The tumor-invaded LA was resected in a 3.5 × 3.0 cm area, with vascular clamping, and the stump was closed with 3-0 Prolene sutures. The surgical margin was free of tumor cells, and the duration of CPB was 28 minutes. The patient was smoothly weaned from CPB. His postoperative course was uneventful, and he received 2 courses of adjuvant chemotherapy. For a combined resection of the LA, it is safer to use CPB than simple vascular clamping, since the latter involves the risk of dislocation. If CPB is used, the tension of the LA is removed by blood extraction into the bypass, and bradycardia is induced by a reduction of body temperature, probably reducing the risk of clamp dislocation. Even when clamp dislocation or bleeding resulting from injury of the LA wall unfortunately takes place during surgery, these events can be dealt with appropriately during the use of CPB.

UI MeSH Term Description Entries
D008175 Lung Neoplasms Tumors or cancer of the LUNG. Cancer of Lung,Lung Cancer,Pulmonary Cancer,Pulmonary Neoplasms,Cancer of the Lung,Neoplasms, Lung,Neoplasms, Pulmonary,Cancer, Lung,Cancer, Pulmonary,Cancers, Lung,Cancers, Pulmonary,Lung Cancers,Lung Neoplasm,Neoplasm, Lung,Neoplasm, Pulmonary,Pulmonary Cancers,Pulmonary Neoplasm
D008297 Male Males
D009361 Neoplasm Invasiveness Ability of neoplasms to infiltrate and actively destroy surrounding tissue. Invasiveness, Neoplasm,Neoplasm Invasion,Invasion, Neoplasm
D011013 Pneumonectomy The excision of lung tissue including partial or total lung lobectomy. Bronchoscopic Lung Volume Reduction,Endoscopic Lung Volume Reduction,Lung Volume Reduction,Lung Volume Reduction Surgery,Partial Pneumonectomy,Partial Pneumonectomies,Pneumonectomies,Pneumonectomy, Partial,Reduction, Lung Volume,Volume Reduction, Lung
D002294 Carcinoma, Squamous Cell A carcinoma derived from stratified SQUAMOUS EPITHELIAL CELLS. It may also occur in sites where glandular or columnar epithelium is normally present. (From Stedman, 25th ed) Carcinoma, Epidermoid,Carcinoma, Planocellular,Carcinoma, Squamous,Squamous Cell Carcinoma,Carcinomas, Epidermoid,Carcinomas, Planocellular,Carcinomas, Squamous,Carcinomas, Squamous Cell,Epidermoid Carcinoma,Epidermoid Carcinomas,Planocellular Carcinoma,Planocellular Carcinomas,Squamous Carcinoma,Squamous Carcinomas,Squamous Cell Carcinomas
D002315 Cardiopulmonary Bypass Diversion of the flow of blood from the entrance of the right atrium directly to the aorta (or femoral artery) via an oxygenator thus bypassing both the heart and lungs. Heart-Lung Bypass,Bypass, Cardiopulmonary,Bypass, Heart-Lung,Bypasses, Cardiopulmonary,Bypasses, Heart-Lung,Cardiopulmonary Bypasses,Heart Lung Bypass,Heart-Lung Bypasses
D006325 Heart Atria The chambers of the heart, to which the BLOOD returns from the circulation. Heart Atrium,Left Atrium,Right Atrium,Atria, Heart,Atrium, Heart,Atrium, Left,Atrium, Right
D006338 Heart Neoplasms Tumors in any part of the heart. They include primary cardiac tumors and metastatic tumors to the heart. Their interference with normal cardiac functions can cause a wide variety of symptoms including HEART FAILURE; CARDIAC ARRHYTHMIAS; or EMBOLISM. Cardiac Cancer,Cardiac Carcinoma,Cardiac Neoplasms,Cardiac Tumor,Cardiac Tumors,Heart Cancer,Heart Tumor,Intracavitary Tumors of the Heart,Myocardial Tumors (Rhabdomyomas and Fibromas),Neoplasms, Cardiac,Neoplasms, Heart,Primary Cardiac Tumors, Childhood,Cancer, Cardiac,Cancer, Heart,Cancers, Cardiac,Cancers, Heart,Carcinoma, Cardiac,Carcinomas, Cardiac,Cardiac Cancers,Cardiac Carcinomas,Cardiac Neoplasm,Heart Cancers,Heart Neoplasm,Heart Tumors,Myocardial Tumor (Rhabdomyomas and Fibromas),Neoplasm, Cardiac,Neoplasm, Heart,Tumor, Cardiac,Tumor, Heart,Tumor, Myocardial (Rhabdomyomas and Fibromas),Tumors, Cardiac,Tumors, Heart,Tumors, Myocardial (Rhabdomyomas and Fibromas)
D006348 Cardiac Surgical Procedures Surgery performed on the heart. Cardiac Surgical Procedure,Heart Surgical Procedure,Heart Surgical Procedures,Procedure, Cardiac Surgical,Procedure, Heart Surgical,Procedures, Cardiac Surgical,Procedures, Heart Surgical,Surgical Procedure, Cardiac,Surgical Procedure, Heart,Surgical Procedures, Cardiac,Surgical Procedures, Heart
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man

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