A Case of Left Lung Cancer with Cerebral Infarction Occurred on the Day following the Conversion of Left S6 Segmentectomy to Lower Lobectomy

Abstract

It is known that cerebral infarction after lung resection is mainly caused by thrombus formation at the surgical stump of the pulmonary vein. A 86-year-old man was diagnosed with left upper lobe lung cancer + left lower lobe lung cancer and was scheduled to undergo passive partial resection of the left upper lobe + S6 segmentectomy. We performed partial resection of the left upper lobe, followed by S6 segmentectomy to treat V6, A6, and B6. However, intraoperative findings determined that S6 segmentectomy was insufficient, and then we converted the operative procedure to left lower lobectomy. The common basal vein was transected at a slightly peripheral site not to involve the V6 stump staple where was precedingly resected ; the basal segmental artery and basal branch were transected to complete left lower lobectomy. On the next day, left hemiplegia suddenly occurred. Following MRI, we diagnosed his illness as postoperative right middle cerebral artery territory infarction. Percutaneous thrombectomy was performed. A chest CT scan confirmed a left lower pulmonary vein stump to be as long as 2.8 cm. Other risk factors causing cerebral infarction could be ruled out with close examinations. We consider that the treatment of the common basal vein at the periphery of V6 staple at the conversion of surgical procedure made the pulmonary vein stump longer and the resultantly formed vein stump thrombus caused cerebral infarction.