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Lobe-selective bronchial blockade may be beneficial when VATS is performed for selected patients with deteriorated lung function.

Quality of life (QOL) after video-assisted thoracic surgical (VATS) lobectomy remains to be defined. Forty-four consecutive patients with clinical stage I lung cancer underwent lobectomy by the VATS approach (n = 22 patients) or thoracotomy approach (n = 22 patients). Acute pain was quantitated by postoperative narcotic requirements and the need for epidural anesthesia. Long-term QOL was assessed by questioning patients about the presence of chronic chest pain, ongoing limitations in arm or shoulder function, time until return to preoperative activity, and satisfaction with the operation. Patients who underwent VATS lobectomy had significant decreases in both acute and chronic chest pain and time until return to preoperative activity. Patients also had more confidence regarding wound size and their overall impression of the operation. In this series, VATS lobectomy was associated with long-term benefits for the QOL in patients with lung cancer. However, the exact role of this approach should be defined by carefully-designed controlled trials studying long-term survival.

A 59-year-old woman was noted to have an anterior mediastinal mass on computed tomography at a regular follow-up 13 years after initial surgery for left breast cancer. Magnetic resonance imaging showed an anterior mediastinal mass. A total thymectomy with excision of surrounding lymphoid tissue was performed. Pathological examination of the resected tumor confirmed the diagnosis of thymic metastasis from breast cancer. The patient has been alive for 6 years after thymectomy. Metastases to the thymus are rare, but long-term survival can be expected with appropriate treatment.

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