Fissure-first bilobectomy of a giant lung abscess combined with a squamous cell carcinoma via a minimally invasive open surgery

Background: Fissureless lobectomies are beneficial for preventing prolonged air leaks (PALs). Despite the widespread use of this technique in lobectomy cases, there have been no reports on fissureless bilobectomies to date.

Case presentation: A 73-year-old man with an 80-pack per year smoking history was diagnosed with a stage 1 primary squamous cell carcinoma in the right lower lobe. He developed a lung abscess inside the tumor 6 weeks after the cancer diagnosis and a surgical resection was planned. A middle and lower bilobectomy was mandatory because of the interlobar pulmonary artery involvement. We chose a fissureless technique to avoid any cancer dissemination and bacterial spillage. The thoracoscopic view revealed that the tumor volume was too large to flexibly mobilize. The minimally invasive open surgery (MIOS) approach was valuable in that it combined direct vision and a thoracoscopic maneuver for treating even a large, distended mass. He was discharged uneventfully 9 days after the operation.

Conclusions: The fissureless bilobectomy, in addition to preventing PALs, was a feasible option for preventing cancer dissemination and bacterial spillage for a lung abscess. The MIOS was a safe and minimally invasive approach for even a giant abscess that inhibited the flexible mobilization of the lung.