Pulmonary artery occlusion post immunotherapy for hilar node-positive lung cancer.

We present the case of a patient who developed pulmonary artery occlusion following immune-checkpoint inhibitor (ICI) therapy for non-small cell lung cancer. A 69-year-old man with squamous cell carcinoma (yc-T1cN0M0), initially diagnosed at c-stage IVA (T3N1M1b), in the upper lobe of the left lung, was scheduled to undergo salvage lung resection after ICI therapy. However, he exhibited an occlusion of the lingular pulmonary artery near the clinically metastatic hilar lymph node. To avoid severe adhesions, the patient underwent successful wedge resection without dividing pulmonary vessels and was discharged without complications. Surgeons should be prepared for pulmonary artery changes following ICI therapy.

[Thoracoscopic Superior and Subsuperior Segmentectomy of the Right Lower Lung for Lung Cancer].

The subsuperior segment (S*) is not frequently observed between the superior (S6) and posterior basal segments (S10). We present a case of video-assisted thoracoscopic surgery of S6+S* segmentectomy for a primary lung cancer patient. A 71-year-old man with a 20-mm nodule on the right S6, suspected of primary lung cancer( cT1bN0M0, stageⅠA2), was admitted to our hospital. Three-dimensional chest computed tomography (CT) revealed a subsuperior segmental bronchus (B*), originating from the common trunk of the lateral basal segmental bronchus( B9) and posterior basal segmental bronchus (B10). In order to obtain enough surgical margin, we performed S6+S* segmentectomy. The pathological diagnosis was invasive adenocarcinoma( pT1cN0M0, stageⅠA3). S* segmentectomy was considered to be useful method to ensure sufficient surgical margin when the lesion is in S* or in segments adjacent to it.

Salvage Surgery for Bronchopleural Fistula Due to Durvalumab and Chemoradiation.

Herein we describe a case of salvage lobectomy for a bronchopleural fistula secondary to durvalumab after chemoradiotherapy in initially unresectable non-small cell lung cancer. A 75-year-old man with adenocarcinoma, c-stage IIIB (T4N2M0) in the upper lobe of the right lung, received durvalumab after chemoradiotherapy. Fourteen months after durvalumab was discontinued, pneumonitis developed followed by peripheral bronchopleural fistula, and he unavoidably underwent salvage right upper lobectomy. The postoperative course was uneventful, and air leakage ceased. After chemoradiotherapy and durvalumab, refractory air leakage may develop that may require salvage surgery.