Uniportal video-assisted thoracoscopic surgery lobectomy with systematic nodal dissection for the treatment of stage IIIA (N2) non-small cell lung cancer: a case report

Uniportal video-assisted thoracoscopic surgery (VATS) has been considered more difficult than multiportal VATS because the operation is performed by inserting 2 or 3 surgical instruments and the thoracoscope into only 1 incision. Therefore, it has been thought that uniportal VATS is not suitable for the treatment of stage IIIA (N2) non-small cell lung cancer (NSCLC). However, the uniportal technique has evolved considerably. Standardized surgical methods make it easy to perform, and the development of surgical instruments and equipment allows for more sophisticated operations. In our institution, uniportal VATS is applied regardless of stage by the author, and complete resection has been successfully performed in N2 disease. One of them is introduced here. A 65-year-old female patient had left upper lobe (LUL) lung adenocarcinoma and left paratracheal, subaortic, and interlobar lymph node metastases. Successful complete resection was achieved with uniportal VATS lobectomy and systematic nodal dissection. The anesthesia time was 225 minutes, and the operative time was 162 minutes. There were no postoperative complications. The chest tube was removed on day 3 postoperatively and the patient was discharged on day 8. The pathologic stage was T2aN2M0. The number of dissected lymph nodes was 52. After surgery, the patient received sequential adjuvant chemotherapy and radiotherapy. The patient is now well over 10 months without any recurrences. In our experience, uniportal VATS lobectomy with systematic nodal dissection in operable N2 lung cancer is a sufficiently applicable operation.