Abstract

Acute respiratory distress syndrome and postoperative acute lung injury remain major causes of morbidity and mortality after thoracic oncologic surgery, largely driven by systemic inflammation, endotoxemia, and subsequent multiple organ failure. In this case report, a 67‑year‑old patient developed severe lung injury and systemic inflammatory response following extended pneumonectomy for lung cancer, with high leukocytosis, elevated endotoxin activity (EAA), interleukin‑6, and procalcitonin, as well as impaired gas exchange and hemodynamic instability despite standard intensive care. A single 4‑hour session of selective hemosorption using a column based on hyper‑cross‑linked styrene–divinylbenzene copolymer with an immobilized LPS‑selective ligand (Efferon LPS) was added to the treatment bundle. The procedure was well tolerated and was followed within 24 hours by a marked reduction in leukocyte count (from 32×10⁹ to 13×10⁹/L), endotoxin activity (from 0.67 to 0.32 units), IL‑6 (from 1860 to 62 pg/mL) and procalcitonin (from 46 to 0.32 ng/mL), normalization of gas exchange indices, and early discontinuation of vasopressor support. Radiographic lung infiltrates regressed and the patient was successfully extubated on postoperative day 3 and transferred from ICU on day 5. This observation supports the clinical feasibility and potential efficacy of LPS‑selective hemosorption as an adjunctive therapy for rapid correction of severe postoperative respiratory complications in oncologic patients and justifies further controlled clinical studies of this novel adsorber technology.