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Thoracoscopic Extended Right Middle Plus Lower Sleeve Lobectomy for Non-Small-Cell Lung Cancer

Complete surgical resection is essential for resectable non-small-cell lung cancer. In selected patients who have received induction therapy, extended ...

Sun Yat-sen University Cancer Center

Pulmonary arterioplasty with an autologous pericardial patch helps avoid having to perform pneumonectomy in patients with locally advanced non-small cell lung cancer. However, a minimally invasive procedure for this technique has rarely been reported because the patch usually shrinks and recoils after retrieval, complicating the suturing procedure. We describe our experience with performing autologous pericardial patch arterioplasty without glutaraldehyde fixation using video-assisted thoracoscopic surgery in a patient who received neoadjuvant immunotherapy. The pulmonary bloodstream was temporarily controlled by an endoscopic tourniquet placed at the pulmonary artery proximal to the ligamentum arteriosum as well as at the inferior pulmonary vein. A pericardial patch harvested anterior to the phrenic nerve was used to repair the hemi-circumferential pulmonary artery defect. Patch angioplasty was performed using a running suture with a 5-0 nonabsorbable monofilament thread, with the epicardial layer facing inside. No graft-related complications including stenosis occurred during the follow-up period.

Minimally invasive autologous pericardial patch reconstruction of the pulmonary artery for locally advanced lung cancer following neoadjuvant treatment.

In patients with resectable non-small cell lung cancer (NSCLC), immune checkpoint inhibitor (ICI)-based regimens in both neoadjuvant and perioperative settings have demonstrated a survival benefit. However, no previous study has compared the efficacy between pure neoadjuvant and perioperative approaches, especially in patients who achieve a substantial pathologic response.

Article	Year
Minimally invasive autologous pericardial patch reconstruction of the pulmonary artery for locally advanced lung cancer following neoadjuvant treatment. Surgery today\| PubMed ID: 39312009	2025
Adjuvant immunotherapy does not improve survival in non-small cell lung cancer with major/complete pathologic response after induction immunotherapy. The Journal of thoracic and cardiovascular surgery\| PubMed ID: 39617319	2025
Surgical techniques for thoracoscopic secondary carinal reconstruction with stepwise barbed sutures. General thoracic and cardiovascular surgery\| PubMed ID: 41511726	2026

Jing-Bo Zhang

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