Abstract Background The independent segment between the superior and basal segments is called the subsuperior segment (S*), which is rarely observed. We report a left S* segmentectomy in a patient with early-stage lung cancer. Case presentation A 72-year-old man presented with a history of hilar cholangiocarcinoma. A left lung ground-glass nodule was detected during follow-up examination. The tumor shadow was localized in the left S* according to the findings of the three-dimensional image analysis system (SYNAPSE VINCENT®) with computed tomography-based analysis. S* segmentectomy was successfully performed with a sufficient surgical margin. The operation time was 147 min, and there was a small amount of bleeding. The pathological diagnosis was invasive adenocarcinoma measuring 3 mm. The tumor was successfully removed with a sufficient surgical margin. The patient was discharged from the hospital 8 days after surgery without any complications. Conclusions S* segmentectomy is not typically performed in patients with lung cancer due to insufficient surgical margins. However, S* segmentectomy is a viable option for selected patients with pulmonary metastasis or early-stage lung cancer.
Abstract Background Knowledge of anatomical abnormalities and variations in pulmonary vessels and bronchi is critical for patients requiring a lung segmentectomy. To the best of our knowledge, this is the first case of a tumor existing in the lower lobe in conjunction with a displaced B 1+2 in which the B 1+2 was not accidentally cut during surgery. Case presentation A 71-year-old woman was referred to our hospital after a part-solid lung cancer was found in the superior segment of her left lung on chest computed tomography. Preoperative three-dimensional computed tomography revealed a displaced anomalous left B 1+2 arising from the left main bronchus and anomalous V 1+2 returning to the inferior pulmonary vein. We identified these anomalies during surgery and performed a left superior segmentectomy. After an unremarkable recovery, the patient was discharged from the hospital on the eighth day postoperative. Conclusions We used a three-dimensional construction system during the preoperative planning of the pulmonary segmentectomy to better understand the bronchovascular structures. When performing surgery where anatomical abnormalities are present, there is the possibility of misidentification. Using the three-dimensional construction system, it was possible to perform safer surgery, as the surgeons were able to preoperatively prepare for any abnormalities.
