Pulmonary infiltration from retroperitoneal carcinoma requiring diaphragm, chest wall and lung resection after thoracoabdominal access

Primary retroperitoneal carcinoma is a rare but highly aggressive tumour often resulting in infiltration of abdominal organs and diaphragm. We describe a case of retroperitoneal carcinoma infiltrating the diaphragm, the lower lobe of the left lung and ribs IX and X, but sparing the abdominal organs. After thoracoabdominal access, our patient underwent resection of the retroperitoneal carcinoma, left hemidiaphragm and ribs IX and X with wedge resection of the left lower lobe. Haematogenous lung metastasis from retroperitoneal carcinoma is well known; on the contrary, direct transdiaphragmatic lung invasion is very rare and requires thoracoabdominal access for a one step operation, representing one of the most stimulating challenges for thoracic surgeons.