T4 spine and thoracic wall invasive lung cancer treatment, case report

Background: Locally advanced lung cancer represents a surgical challenge in terms of adding years of good quality of life to patients while avoiding the complications of surgery, which is why new techniques are developed despite its complexity. Case Description: We present this case where a possible therapeutic diagnostic process with good outcomes is exposed, which adds it as a valid treatment in centers that have experience. We present a patient, former smoker, that consults with pleuritic pain and cough for 2 weeks of evolution, those were initially interpreted as a pneumonia/empyema, resistant to antibiotic treatment. However, a positron emission tomography-computed tomography (PET-CT) scan found a mass in the posterior segment of the right upper lobe (RUL) and bullae, a negative mediastinoscopy and CT scan were obtained, which reported an invasion of T6 and the costovertebral joint, a needle biopsy was performed that reported: undifferentiated carcinoma with necrosis. It was decided to perform a resection of the spinous processes and transverse processes plus a laminectomy and a vertebrectomy of T6 and T7 and an upper right lobectomy, and a resection of posterior rib arches 5, 6, 7 and 8. The pathological anatomy results obtained were: large cell carcinoma. The patient was recovered and pending on oncological treatment. Conclusions: Vertebral and pulmonary resections are technically possible, although they must be performed in centers with experience in those procedures, thus reducing the possibility of residual disease or post-surgical complications.