Pulmonary artery reconstruction using a common basal artery wall flap in completion left lower lobectomy after S⁶ segmentectomy

Abstract

Pulmonary artery reconstruction has become acceptable in radical pulmonary resection for locally advanced lung cancer to preserve the pulmonary parenchyma, and should be performed to spare large lingular branches arising from the distal to superior segmental branches of the left lower lobe during left lower lobectomy. A 69-year-old woman who underwent left S⁶ segmentectomy for pulmonary metastasis of rectal cancer 4 years previously with stump recurrence (2.2 × 1.4 cm) of the left lower lobe adjacent to the left pulmonary artery was admitted for surgery. Chest computed tomography revealed an interlobar lingular artery type with both superior and inferior lingular arteries arising from the left interlobar pulmonary artery. Posterolateral left thoracotomy was performed. The lung strongly adhered to the chest wall throughout the thoracic cavity and aorta. Therefore, adhesiolysis was performed first. The inferior pulmonary vein and left lower bronchus were stapled before dissection of the pulmonary artery. The left pulmonary artery could not be separated from the tumor because the adhesions were strong and extensive. The pulmonary artery was isolated and clamped after an intravenous injection of heparin sodium. The adhered pulmonary artery was resected en bloc with the left lower lobe. The wall flap was flipped and tailored to the defect and then sutured with nonabsorbable monofilament material. We present a patient who successfully underwent pulmonary artery reconstruction using a common basal artery wall flap to preserve lingular branches during completion left lower lobectomy.