Case of Successful Surgical Resection of Locally Advanced (T4) Lung Cancer Utilizing a Multi-Disciplinary Approach Involving Previously Unresectable Structures

Background: Lung cancer is the leading cause of cancer death worldwide and the second most prevalent cancer in the world.(1) Tumor node metastasis (TNM) staging continues to serve as the primary prognostic factor for survival in lung cancer. TNM classification (8th edition) characterizes T4 disease as a tumor exceeding 7 cm in its largest dimension or one that invades structures such as the mediastinum, diaphragm, heart, great vessels, recurrent laryngeal nerve, carina, trachea, esophagus, spine or represents a separate tumor in a different lobe of ipsilateral lung.(2) These structures are typically deemed “unresectable”.(3) Case: We present the case of an asymptomatic 66-year-old gentleman with an incidental lung nodule found on routine pre-operative chest x ray. In this case, imaging revealed local extension, involving the stomach (excluded from TNM classification), diaphragm and pericardium. Consequently, the disease was initially considered incurable. Nevertheless, through collaborative multi-disciplinary surgical approach, successful resection was achieved. Conclusion: T4 disease exhibits heterogeneity, and although it is typically deemed unresectable, recent developments in surgery are challenging this conventional belief and demonstrating the potential benefits of surgical resection, particularly where a radical dissection is anticipated.