In conclusion, en bloc pneumonectomy followed by a back-table procedure and auto-lung-transplantation for locally advanced lung cancer does not prolong operation time due to both easier lung separation on the back table and simultaneous lymph node dissection by another surgeon. In addition, lung irrigation with cold lung preservation solution prevented ischemia-reperfusion injury in the present case. We are continuing to examine our novel protocol to determine its suitability as a surgical option.