Situation

A patient ahs a tumour that extends form the pulmonary artery to the chest wall. The hilum is suitable for pneumonectomy, and their PFTs are adequate for this resection. What would you do for chest wall ?

Opinion

Opinion

The first question is whether the patient has any chest wall pain. If none, then an extra pleural strip may be all that is needed. CT scanning and bone scans are good positive predictive tests but poor negative predictive tests for the chest wall. MRI could be used.

This question boils down to performing a pneumonectomy and either an extrapleural strip or chest wall resection. The location of the chest wall involvement, probably being critical. 

An additional important point is the role of chemo and radiotherapy to reduce the size of the tumour before surgical resection. As the tumour is very big radiotherapy would not be appropriate, as too large a field and physical size of lesion. Therefore chemotherapy remains the only option for neoadjuvant therapy.