A case series of VATS intrapericardial pneumonectomy: a bi-centric experience.

Abstract

Background: Intrapericardial pneumonectomy is a complex procedure indicated for large lung tumors where safe dissection of major vascular structures outside the pericardium is unfeasible or when the pericardium itself is invaded. Traditionally managed via open thoracotomy, recent advancements in VATS techniques now allow for intrapericardial pneumonectomy even in cases with extensive tumors or locally advanced disease. In this article, we detail the clinical outcomes and surgical considerations of six patients with non-small cell lung cancer who underwent VATS intrapericardial pneumonectomy. In this article, we detail the clinical outcomes and surgical considerations of six patients with non-small cell lung cancer who underwent VATS intrapericardial pneumonectomy.

Case presentation: This study analyzed data from 24 patients who underwent VATS pneumonectomy for non-small cell lung cancer at two thoracic surgery centers in Turkey between January 2015 and March 2024. Among them, 6 patients underwent intrapericardial pneumonectomy; 5 had left pneumonectomy, and 1 had right pneumonectomy. All patients were male, with a mean age of 72.8 years, and a mean tumor size of 6.2 cm. Pericardial invasion was observed in 5 patients. Postoperative complications included respiratory failure and septic shock in one patient, leading to death. Long-term follow-up showed one additional death due to cancer progression; four patients are alive and under routine follow-up.

Conclusions: VATS intrapericardial pneumonectomy offers a viable alternative to traditional open surgery for patients with large or locally advanced non-small cell lung cancer, providing enhanced visualization, reduced postoperative pain, and faster recovery. Our multi-center experience with six patients demonstrates the procedure's feasibility and safety, even in challenging cases with pericardial invasion. Despite the complexity of the surgery, the use of advanced VATS techniques and careful intraoperative assessments can lead to successful outcomes. However, given the associated risks, especially with postoperative complications, further studies with larger cohorts are needed to validate these findings and refine surgical techniques.