One-stage operation for thoracic aortic arch aneurysm and left lung carcinoma: a case report
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CASE REPORT
Open Access
One-stage operation for thoracic aortic arch aneurysm and left lung carcinoma: a case report Takashi Makino1, Kota Kawada1, Hiroshi Masuhara2, Yoshinobu Hata1, Hajime Otsuka1, Satoshi Koezuka1, Naobumi Tochigi3, Kazutoshi Shibuya3, Yoshinori Watanabe2 and Akira Iyoda1*
Abstract Background: The simultaneous surgical treatment of thoracic aortic arch aneurysm (TAA) and lung carcinoma is extremely rare. Case presentation: We report the simultaneous surgical treatment of TAA and squamous cell carcinoma of the lung in a 72-year-old Japanese man. We performed a one-stage operation that consisted of aortic arch replacement for aortic arch aneurysm with a 3-branched artificial vessel under separate cerebral and systemic extracorporeal circulation, and left upper lobectomy for lung cancer via a left lateral thoracotomy. Conclusions: Although patients should be carefully selected for this procedure, the simultaneous surgical treatment of TAA and lung carcinoma can be performed safely. Keywords: Surgery, One-stage operation, Aortic arch aneurysm, Lung carcinoma
Background The surgical management of coexisting cardiovascular disease and lung cancer remains controversial [1, 2]. The treatment of patients with resectable lung carcinoma and coexisting cardiac disease is problematic because of the increased operative mortality of lung resection [3]. Usually, the surgical methods are staged, with cardiac surgery performed first followed by lung resection at a later date. However, when resection for lung carcinoma is delayed, the immunosuppressive effects of cardiopulmonary bypass may have a harmful effect on the growth of lung carcinoma, leading to metastases [3]. In this report, we present a patient who had a one-stage operation that consisted of aortic arch replacement for aortic arch aneurysm with a 3-branched artificial vessel under separate cerebral and systemic extracorporeal circulation, and left upper lobectomy for lung carcinoma. The management of the patient with TAA and lung cancer is challenging, and previous reports on the simultaneous surgical treatment of TAA and lung carcinoma are extremely rare. * Correspondence: [email protected] 1 Division of Chest Surgery, Toho University School of Medicine, Tokyo, Japan Full list of author information is available at the end of the article
Case presentation A 72-year-old man was referred to our hospital because of an abnormal pulmonary shadow found on a routine chest X-ray. Chest X-rays revealed a mass shadow in the left middle lung field and a positive silhouette sign for the left second arch (Fig. 1). The aortic arch aneurysm was saccular aneurysm associated with a greater risk of rupture, and connected to the pulmonary mass in the left upper lobe with a possible risk of tumor adhesion or invasion to the aneurysm (Fig. 2). Threedimensional CT revealed that the aortic aneurysm was located in front of the arch near the left subclavian artery, and the brachiocephalic and left common carotid arteries branched from the aorta with a common duct (F
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