Salvage pulmonary metastasectomy with auto-transplantation after nivolumab

A 64-year-old woman presented for potential salvage surgery with a residual and growing pulmonary metastasis from clear-cell renal cell carcinoma, originating in the left upper lobe, after immunotherapy with nivolumab. Preoperative computed tomography with contrast demonstrated that the lesion extended into the pulmonary artery branch of the anterior segment of the left lower lobe. Ex vivo dissection was performed, followed by auto-transplantation of the left lower lobe. Herein, we discuss the radiological, intraoperative and pathological findings.