VATS lobectomy in a lung cancer patient with HIV infection

Background. Although the incidence of lung cancer in patients with HIV infection is increasing, case reports of surgery performed on such patients are rare in Japan. Case. A 57-year-old man was given a diagnosis of previously unrecognized HIV infection during hospitalization for pneumonia. Highly active antiretroviral therapy was started at that time. Five years later, a chest radiograph revealed an abnormal shadow in his left upper lung field. A computed tomography (CT) scan of the chest showed a pulmonary nodule with spicule formation and pleural indentation in the left upper lobe. 18-fluorodeoxyglucose positron emission tomography (FDG-PET) showed abnormal uptake in the pulmonary nodule and left hilar lymph nodes, and lung cancer was suspected. We used video-assisted thoracic surgery (VATS) to perform a left upper lobectomy and mediastinal lymph node dissection. His postoperative course was uneventful. Pathological diagnosis was adenocarcinoma (pT1N2M0, stage IIIA). We tried to reduce the perioperative risk of acquiring a blood-borne infection by reducing the frequency of contact with his blood. Conclusion. We can operate on HIV-infected individuals as well as non-infected patients if their general condition is good. VATS is useful, because the risk of coming into contact with the patient's blood is lower than with open surgery.