Key result
A 42-year-old woman successfully underwent a left sleeve pneumonectomy under cardiopulmonary bypass for adenoid cystic carcinoma and remained well without tumor relapse 20 months after surgery.
Case Report (n=1)
Cardiopulmonary bypass can be safely utilized to manage hemodynamic instability during complex thoracic surgeries such as left sleeve pneumonectomy for large tumors.
Extracorporeal support enabled safe left sleeve pneumonectomy in this T4 case; single report leaves open its role in high-risk central resections.
症例は56歳女性．左肩痛にて前医を受診し，胸部CTにて気管分岐部より左側にかけて長径45 mm大の腫瘤を認め当院紹介となった．気管支鏡検査にて左主気管支入口部より右上葉支分岐部近傍まで腫瘍の進展を認めた．腺様囊胞癌（cT4N0M0 cStage IIIA）と診断され手術の方針となった．腫瘍が大きく腫瘍周囲の操作に伴い循環動態が不安定になる事が予想され，体外循環使用も考慮し胸骨正中切開でアプローチした．術中，腫瘍背側の剥離操作に伴う上行大動脈及び右主肺動脈の圧排により循環動態が不安定になったため，体外循環補助を行った．右主気管支を切離し，術野挿管にて右肺換気を開始した．気管分岐部及び左肺を摘出し，気管と右主気管支を吻合した．術後経過は良好で術後20ヵ月無再発生存中である．体外循環を使用することで安全な手術が可能となったleft sleeve pneumonectomyの1例を経験したため報告する．
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Kuroda et al. (2019) conducted a case report in Adenoid cystic carcinoma (n=1). Left sleeve pneumonectomy under cardiopulmonary bypass was evaluated on Tumor relapse and survival. A 42-year-old woman successfully underwent a left sleeve pneumonectomy under cardiopulmonary bypass for adenoid cystic carcinoma and remained well without tumor relapse 20 months after surgery.
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