Right Middle Lobe Preserving Right Upper Lobectomy after Right Lower Lobectomy for Metachronous Lung Cancer—A Case Report—

Abstract

The patient was a man in his 63-year-old who had undergone right lower lobectomy + lymph node dissection for cancer of the right lower lobe of the lung (pT2N0M0, squamous cell carcinoma) in our hospital 16 years previously. He had been free from recurrence for postoperative 5 years and his periodic follow-up studies were terminated. A chest X-ray film taken at a medical checkup revealed an abnormal shadow. A chest CT scan for close exploration showed a ground-glass opacity appearance 28 mm in maximum diameter including a solid portion in the center of S1b in the right upper lobe. Bronchoscopic lung biopsy revealed the diagnosis of pulmonary adenocarcinoma, cT1bN0M0 cStage I A2. We thus performed right middle lobe preserving right upper lobectomy. As we confirmed funicular adhesion of the middle lobe to the inferior mediastinum during surgery, no preserving strategy to prevent tosion of the middle lobe was necessary. His postoperative course was uneventful and the residual middle lobe did no have a problems in expansion. He was discharged from our hospital. The histological stage was pT1c(4)N0M0 pStage I A3, and other three lesions which could not be predicted before surgery were found. After the surgery expansion of the residual middle lobe is satisfactory.

When the middle lobe is preserved after right upper or lower lobectomy, lobectomy of the residual lobe may pose a problem of causing torsion of the muddle lobe. However, we did not need any strategies to prevent the middle lobe torsion due to the postoperative restiform adhesion.