Port-access thoracoscopic anatomical lung multiplex subsegmentectomy: S6b-S8a-S9a trisubsegmentectomy

Area of Science:

• Thoracic Surgery
• Pulmonology
• Surgical Oncology

Background:

• Lung nodules require careful evaluation, especially in patients with underlying conditions like chronic obstructive lung disease (COPD).
• Increasing nodule size on serial imaging, such as chest computed tomography (CT), can raise suspicion for primary lung cancer.
• Accurate localization and surgical planning are crucial for effective lung nodule management.

Purpose of the Study:

• To report the successful surgical management of a lung nodule suspicious for malignancy.
• To demonstrate the efficacy of thoracoscopic anatomical multiplex subsegmentectomy for selected lung cancers.
• To present a long-term follow-up outcome of a patient treated for lepidic adenocarcinoma.

Main Methods:

• A 77-year-old male patient with COPD and a growing left lung nodule (1.9 cm) underwent CT-simulated thoracoscopic anatomical left S6b-S8a-S9a multiplex subsegmentectomy.
• Surgical procedure details included operative time (142 min) and blood loss (13 mL).
• Postoperative management focused on monitoring for complications like air leakage and chest tube removal timing.

Main Results:

• The surgery was completed with minimal blood loss and no observed air leakage, allowing for chest tube removal on postoperative day 1.
• Histopathological analysis confirmed the final diagnosis of lepidic adenocarcinoma.
• The patient experienced a favorable outcome, remaining disease-free for four years following the intervention.

Conclusions:

• Thoracoscopic anatomical multiplex subsegmentectomy is a viable and effective minimally invasive surgical option for managing selected lung nodules.
• Lepidic adenocarcinoma can be successfully treated with sublobar resection, achieving excellent long-term oncological outcomes.
• This case highlights the importance of precise surgical techniques and individualized patient management in thoracic oncology.