TY - JOUR
AR - IJSCR-2019-2-105
TI - Surgical Management of Primary Pulmonary Mucoepidermoid Carcinoma of the Proximal Left Mainstem Bronchus
AU -  Patrick , G. Chan
AU - Chigozirim , Ekeke
AU - Diane , Strollo
AU - Ernest G., Chan
AU - Humberto E , Trejo Bittar
AU - James D. , Luketich
AU - Rajeev, Dhupar
JO - International Journal of Surgical Case Reports
PY - 2019
DA - Thu 29, Aug 2019
SN - 2674-4171
DO - http://dx.doi.org/10.31487/j.IJSCR.2019.02.05
UR - https://www.sciencerepository.org/surgical-management-of-primary-pulmonary-mucoepidermoid-carcinoma-of-the-proximal-left-mainstem-bronchus_IJSCR-2019-2-105 
KW - primary mucoepidermoid carcinoma, airway resection, multidisciplinary tumor board
AB - A 29-year-old non-smoking female with a history of recurrent AML presented with worsening dyspnea. A
CT scan revealed an 8 X 7 mm polypoid soft tissue nodule 8 mm distal to the carina in the left mainstem
bronchus. She was brought to the operating room and a nearly obstructing soft fleshy tumor in the left
mainstem bronchus just distal to the carina was removed with bronchoscopy. Pathology revealed a low
grade mucoepidermoid carcinoma 0.8 cm in largest dimension with negative margins. The patient returned
for a resection and was intubated with a right mainstem double lumen tube and placed in left lateral
decubitus. After posterolateral thoracotomy, the azygos vein was divided to mobilize the esophagus and
retract it laterally. Level 4 and 7 lymph node dissection were performed to obtain access to the anterior
tracheal and subcarinal spaces. There was minimal dissection lateral to the trachea to minimize risk of
ischemia. One centimeter of trachea just proximal to the carina was circumferentially isolated with
umbilical tape for retraction. We bronchoscopically confirmed the location for transection and advanced a
jet ventilator catheter distally. We resected one centimeter of left mainstem bronchus. We inspected the
lumen of the airway to confirm no gross residual disease and confirmed negative pathologic margin before
performing an end-to-end anastomosis with interrupted absorbable sutures under both jet and cross-table
ventilation. Postoperatively, the patient had an uncomplicated course and was discharged without any
supplemental oxygen on postoperative day 6. Final pathology was low grade mucoepidermoid carcinoma,
T1aN0