Combined off-pump minimally invasive cabg and uniportal lobectomy for lung cancer

Patients with early-stage lung cancer and concomitant coronary artery disease increasingly require combined management. In carefully selected patients, simultaneous minimally invasive cardiac and thoracic surgery may reduce overall treatment burden while avoiding delays in definitive oncologic therapy. A 76-year-old woman presented with a 3.8-cm right middle lobe lung mass and symptomatic proximal left anterior descending coronary artery disease with exercise-induced myocardial ischemia. Following multidisciplinary Heart Team discussion, a one-stage minimally invasive strategy was selected to avoid delayed lung resection associated with dual antiplatelet therapy after percutaneous coronary intervention. The patient first underwent off-pump minimally invasive coronary artery bypass grafting using the left internal mammary artery to the left anterior descending artery through a left anterior mini-thoracotomy. After protamine reversal, she was repositioned and underwent uniportal video-assisted thoracoscopic right middle lobectomy with systematic hilar and mediastinal lymph node dissection following intraoperative frozen-section confirmation of malignancy. Recovery was uneventful, and she was discharged on postoperative day 5. Final pathology demonstrated a pT2aN0M0 (PL2) moderately differentiated adenosquamous carcinoma with negative surgical margins. This case demonstrates that simultaneous MIDCAB and uniportal VATS lobectomy can be a feasible treatment option for carefully selected patients with concomitant coronary artery disease and operable lung cancer when supported by multidisciplinary Heart Team evaluation and meticulous perioperative planning.