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A 49-year-old male patient was operated on by the authors for a T4 (left atrium invasion) squamous cell carcinoma in the right lower lobe (Figure 1). pTNM was T4N0MO and four cycles of chemotherapy were given as adjuvant therapy. After four years of follow-up care, a chest CT showed a newly developed tumor (2.9cm) in the superior segment of the left lower lobe (Figure 2). Since there was no other increased FDG uptake in another part of the body, resection of the tumor was recommended by the Tumor Board.
The authors reserve segmental resections for lung cancer treatment in patients with limited pulmonary functions, resection of metastasis, or small-sized second primary lung cancer with no lymph node metastasis. Intraoperative frozen section pathology is performed at every step of the segmentectomy operation to avoid an incomplete oncological surgery. If appropriate in terms of the intraoperative findings and frozen section pathological analyses, the authors planned to perform a single-incision VATS (SIVATS) superior segmentectomy of the left lower lobe.
SIVATS remains a feasible approach in anatomical lung resections including lobectomy, pneumonectomy, and segmentectomy. With its single intercostal entrance feature, SIVATS seems advantageous over not only thoracotomy but also over standard 3-port VATS and robotic operations. However, further comparative analyses of different approaches remain necessary for a scientific conclusion.
Figure 1
Figure 2
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2 Comments
What was the reason not performing a lobectomy in this 49 year old? Interesting case and thank you for the video
Thank you for your question. Although some studies report almost equivalent long-term outcome with segmentectomy, we too perform lobectomy in stage I PRIMARY lung cancer. Since there was a 4-year period between the primary lung cancer in the right lung, the tumor in the left lung had been considered as a metachronous tumor in this patient. With systematic lymph node assessment and surgical border confirmation by intraoperative pathology, an anatomical lung resection – segmentectomy – was planned. I believe that parenchyma-saving anatomical resection for stage I disease is a feasible approach especially in a patient where recurrent lung cancers exist. However, lobectomy remains an option all the time when frozen pathology reveals any lymph node involvement or suspicious surgical margins.