Left apicoposterior segmentectomy for lung cancer with displaced segmental bronchus: a case report
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(2020) 15:274
CASE REPORT
Open Access
Left apicoposterior segmentectomy for lung cancer with displaced segmental bronchus: a case report Masahiro Yanagiya1,2* , Hirokazu Yamaguchi2, Noriko Hiyama1 and Jun Matsumoto1
Abstract Background: Pulmonary segmentectomy can be challenging when thoracic surgeons encounter anatomical anomalies. A displaced left apicoposterior bronchus is a rare bronchial anomaly that makes lung anatomical resection challenging. We herein present a case of successful left apicoposterior segmentectomy for lung cancer in a patient with an anomalous segmental bronchus. Case presentation: A 70-year-old man was clinically diagnosed with early-stage lung cancer for which segmentectomy was indicated. A preoperative image revealed a displaced left apicoposterior bronchus that branched behind the left main pulmonary artery. With the aid of three-dimensional reconstruction imaging and systemic indocyanine green injection, we successfully performed left apicoposterior segmentectomy under complete video-assisted thoracic surgery. The pathological diagnosis was adenocarcinoma. The patient was alive without recurrence 8 months after segmentectomy. Conclusion: Preoperative three-dimensional imaging and systemic indocyanine green injection enabled us to successfully conduct challenging segmentectomy in a patient with an anomalous bronchus. Keywords: Thoracic surgery, Lung cancer, Segmentectomy, Bronchial anomaly
Background Although the optimal surgical treatment for lung cancer has long been lobectomy, segmentectomy may become a standard treatment for early-stage lung cancer [1]. Previous studies have shown that segmentectomy is oncologically comparable with lobectomy for early-stage lung cancer [2]. Segmentectomy also has the advantage of preservation of lung function [2, 3]. Segmentectomy requires a higher degree of skill than lobectomy for thoracic surgeons [1]. Moreover, segmentectomy is often challenging when thoracic surgeons encounter anatomical anomalies during surgery. A * Correspondence: [email protected] 1 Department of General Thoracic Surgery, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo 141-8625, Japan 2 Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
displaced left apicoposterior bronchus (B1 + 2) is a bronchial anomaly that thoracic surgeons sometimes encounter [4]. Although previous reports have described lobectomy for lung cancer with a displaced left B1 + 2, few reports have described segmentectomy for an anomalous bronchial branch [5–7]. We herein report a case of successful left apicoposterior segmentectomy for lung cancer in a patient with a displaced segmental bronchus using video-assisted thoracic surgery (VATS) with the aid of recently developed advanced techniques.
Case presentation A 70-year-old man with no symptoms and a history of diabetes mellitus and subsequent chronic kidney disease was referred to our hospital because an abnormal lung nodule had been detected by chest computed tomography
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