Locally Advanced Lung Cancer Treated with Autologous Lung Transplantation in Shanghai General Hospital to Preserve Lung Function As Much As Possible

Link of the original article:https://mp.weixin.qq.com/s/l_WtmKL8dGk2IsnrLrsNCw

The left-sided lung with the tumor was resected as a whole, and "trimmed" in special preservation solution outside the body to remove the upper lobe with tumor while the lower lobe being kept intact. The intact lower lobe was put back into cavity for reanastomosis. Recently, the surgical team led by Prof. Fan Jiang, director of thoracic surgery at Shanghai General Hospital, with the assistance of the anesthesiology department and the nursing team from the operating room, successfully completed an autologous lung transplant for a patient with locally advanced central squamous carcinoma of the upper lobe of the left lung in about four hours. Not only was the tumor resected oncologically, but also the patient’s lung function and life quality were kept maximally. The patient recovered very well and will be discharged from the hospital soon.

The patient, aged 64, was diagnosed with central squamous carcinoma in the upper lobe of the left lung. The CT scan showed that the tumor was too large and close to the hilum. If he underwent surgery first , he would probably have to have his left lung removed and spend his rest life with only right-sided lung to breathe, which would seriously affect his quality of life. After multidiscipline-team discussion, the regimen was decided with 2 cycles of neo-adjuvant chemotherapy combined with PDL1 inhibitor treatment, followed by surgery as appropriate.

In the following two months, the patient completed two cycles of neoadjuvant chemo+immno-therapy. After MDT discussions, surgery was finally decided for the patient. The surgical team made careful and detailed plans including Plan A being pneumonectomy, Plan B convention sleeve lobectomy, and Plan C autologous lung transplantation. All the plans were reviewed the day before the surgery with others teams: anesthesiology department and the nursing team of the operating room. 

Intraoperatively , the tumor in the upper lobe was found to invade a long segment of left main pulmonary artery and left main bronchus. Conventional sleeve lobectomy of Plan B is impossible. Pneumonectomy of Plan A could be considered. If so, removing the whole left lung would cause great damage and might even threaten his life. Autologous lung transplantation of Plan C, which could preserve lung function more, seems the best option for the patient. So the working flow of autologous lung transplantation was initiated. The surgery was performed by Prof. Fan Jiang, director of thoracic surgery, and Prof. Huang Wei, deputy chief physician, assisted by Dr. Chen Xi and Dr.Qu Jichen, two attending physicians. The procedure of autologous lung transplantation consists of the following steps : 1, pneumonectomy to take out the whole lung of left side; 2, excorporeal lobectomy to resect targeted lobe with tumor and preserve the uninvolved lobe; 3 Irrigation to flush out the blood from the preserved lobe; 4 Implantation to  reconnect the preserved lobe to the body by anastomosis of bronchus, artery and vein. Although this procedure is quite challenging for surgeon, also in need of well-established cooperation with other teams, it was performed successfully by us. On the first day after surgery, the patient was transferred from the intensive care unit back to the general ward after clinical rounding confirmed his stable recovery.

Correspondents: Xiangnan Xu, Xing Wang, Wei Huang