Recently, Oto et al. presented a case of auto-lung transplantation for central type advanced lung cancer using a technique of ex situ lung irrigation with cold lung preservation solution (low-potassium dextran glucose solution) and ex situ division of the graft [5]. Watanabe et al. also reported that in a more complicated case [6]. In reports of lung transplantion, proper lung preservation is recommended for cases in which the warm-ischemic time exceeds 1 h [7], with greater than 2 L of a cold low-potassium phosphate-buffered lung preservation solution recommended for the donor operation. To complete pulmonary vessel irrigation with 2 L of antegrade and retrograde flushing, an ex situ back-table procedure following an en block pneumonectomy is safer and easier. Furthermore, Oto et al. noted that ex situ graft resection on the back table following en bloc pneumonectomy is easier and safer as compared to in situ resection [5]. As a result, the operation time may be shortened. In addition, a simultaneous mediastinal lymphadenectomy performed by another surgeon can reduce the time required. In the present case, auto-lung transplantation with use of a back-table procedure did not prolong the operation time as compared to a basal-segment-preserving ESL technique (Fig. 2).