Situation
A patient has a lesion in the apex of the LUL, and also a lesion in the RML.
Both are small nodules. The one in the LUL is amenable to wedge resection. Unfortunately
the FEV1 is only 50 %. What would you do ?
A tissue diagnosis should be sought here if at all possible. These could be two primaries or secondaries. Options include a wedge top the LUL, followed by a RM Lobectomy. The prognosis depends on the worst stage of each tumour. The adventurous surgeon may attempt a median sternotomy as this is less painful than thoracotomy, and allows both lesions to be dealt with simultaneously.