CASE PRESENTATION: A 64-year-old diabetic man, with 160-pack-year tobacco history, was diagnosed with 6.3-cm right upper lobe (RUL) lung mass, with enlarged hilar and subcarinal lymph nodes (LNs), but without distant metastasis. Needle biopsies of the RUL lung mass and para-azygous LNs revealed CK7-positive/TTF1-positive adenocarcinoma, confirming stage-3A NSCLC. Gastric volvulus, complicating his paraesophageal hernia, was treated non-surgically but delayed initiation of induction therapy. He then underwent induction carboplatin/paclitaxel chemotherapy x7 weeks, with concurrent 50-Gy XRT in 35 fractions. Laparoscopic reduction of paraesophageal hernia and resection of hiatal hernia sac, followed by robotic-assisted laparoscopic crurapexy and Nissen fundoplication. Under same anesthesic, he underwent robotic-assisted thoracoscopic RUL lobectomy and mediastinal LN dissection. Total operative (skin-to-skin) time was 545 min, with 341 min for paraesophageal hernia repair and 204 min for lobectomy, with estimated blood loss of 360 mL. Postoperative course was complicated by pulmonary embolus on postoperative day (POD) #3, atrial fibrillation with rapid ventricular rate on POD#5, dysphagia requiring repeated swallow evaluations and slow advance to regular diet, prolonged air leak, and enlarging right pneumothorax after chest tube removal, requiring CT-guided right pleural pigtail catheter. Pathology revealed 4-cm poorly-differentiated carcinoma, 99% necrotic or fibrotic, with all 13 hilar and mediastinal LNs uninvolved by NSCLC. On POD#17, he was discharged home on therapeutic dalteparin, with pigtail catheter connected to Pneumostat valve, removed on POD#26.