A case of video-assisted thoracoscopic right upper lobectomy for lung cancer with an anomalous bronchus

Abstract

Anomalous bronchial branching, such as displaced bronchus or supernumerary bronchus, is rare, and there are multiple considerations in lung cancer surgery, including incomplete lobulation, vascular anomalies, and the optimal range of resection. We report a case of video-assisted thoracoscopic right upper lobectomy for lung cancer with two bronchial abnormalities. An 80-year-old woman was referred to our hospital for surgery for lung cancer (adenocarcinoma, cT2bN0M0 cStage IIA). Preoperative computed tomography and bronchoscopy revealed an anomalous right B3 branching from the middle lobe bronchus and a right B7 bronchial defect. Complete video-assisted right upper lobectomy was performed. The B3 branch was traced to its bifurcation from the middle lobe, and after dissecting the surrounding lymph nodes, it was divided. Mediastinal lymph node dissection were performed, and the pathological diagnosis was adenocarcinoma (pT2bN0M0 pStage IIA). In lung cancer surgery with anomalous bronchus, detailed preoperative anatomical assessment is necessary for safe surgery, and the range of lung resection and lymph node dissection should be considered in each case.