Hybrid video-assisted thoracoscopic surgery lobectomy and en-bloc chest wall resection for non-small cell lung cancer.

Chest wall invasion is seen in 5% to 8% of patients presenting with lung cancer. We report a case of complete resection of a 14 cm × 9 cm pT3N0M0 squamous cell carcinoma arising from the right lower lobe and invading the lower chest wall posteriorly, in a 75 years old male, via a hybrid thoracoscopic [video-assisted thoracoscopic surgery (VATS)] approach. Following conventional VATS lobectomy, a targeted 10 cm incision was performed to allow wide resection of the 7th to 10th ribs and 6th to 9th transverse processes, with the defect being subsequently reconstructed with a composite rigid prosthesis. The patient made an uneventful recovery, and was discharged on the 3rd postoperative day; with later adjuvant chemotherapy. Thoracoscopic surgery is not currently widely adopted in patients with chest wall invasion, likely due to the technical difficulties. We briefly review the various techniques described in the current literature, whilst emphasising a role for such an approach in highly selected cases.