Abstract
Few reports have described right upper and lower lobectomy with preservation of the middle lobe because of the risk of middle lobe torsion or emphysematous change. Herein we describe a successful result following lobectomy with preservation of the middle lobe for metachronous pulmonary metastasis originating from colon cancer in the right upper lobe after initial right lower lobectomy. A 69-year-old man who had undergone right lower lobectomy for pulmonary metastasis originating from colon cancer 3 years earlier was diagnosed as having suspected metachronous pulmonary metastasis in the right upper lobe. Because preoperative computed tomography (CT) indicated that the distance between the tumor and the entrance of the upper bronchus was 20 mm, it was considered difficult to achieve complete resection by a wedge resection or segmentectomy. Furthermore, preoperative CT demonstrated compensatory hypertrophy of the middle lobe and elevation of the right diaphragm, thus reducing the size of the thorax. Therefore, right upper lobectomy with middle lobe preservation was planned. The operation was performed using a totally thoracoscopic approach. Adhesion of the upper lobe to the chest wall was easily detached. As the middle lobe adhered to the chest wall, this served to prevent middle lobe torsion. The fissure between the upper and middle lobes had fused because of adhesion resulting from the initial lower lobectomy. Therefore, an ‘anterior fissureless approach’ was adopted to avoid any postoperative air leakage. There were no intraoperative problems, and the postoperative course was uneventful. The patient was discharged on postoperative day 6. Pathological examination of the specimen confirmed that the tumor was a metachronous pulmonary metastasis originating from the colon cancer. Four months after the operation, he had no requirement for additional oxygen support, and postoperative CT demonstrated a sufficiently expanded residual middle lobe without emphysematous change.
Highlights
Few reports have described right upper and lower lobectomy with preservation of the middle lobe because of the risk of middle lobe torsion or emphysematous change. we describe a successful result following lobectomy with preservation of the middle lobe for metachronous pulmonary metastasis originating from the colon cancer in the right upper lobe after initial right lower lobectomy.Case presentation A 69-year-old man who had undergone right lower lobectomy 3 years earlier for pulmonary metastasis originating from colon cancer consulted our hospital becausePreoperative forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1.0) were 2,580 and 1,330 ml, respectively
We describe a successful result following lobectomy with preservation of the middle lobe for metachronous pulmonary metastasis originating from the colon cancer in the right upper lobe after initial right lower lobectomy
When right upper lobectomy is required for lung disease after initial right lower lobectomy, pneumonectomy can be considered instead of lobectomy with preservation of the middle lobe
Summary
Few reports have described right upper and lower lobectomy with preservation of the middle lobe because of the risk of middle lobe torsion or emphysematous change. we describe a successful result following lobectomy with preservation of the middle lobe for metachronous pulmonary metastasis originating from the colon cancer in the right upper lobe after initial right lower lobectomy.Case presentation A 69-year-old man who had undergone right lower lobectomy 3 years earlier for pulmonary metastasis originating from colon cancer consulted our hospital becausePreoperative forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1.0) were 2,580 and 1,330 ml, respectively. Background Few reports have described right upper and lower lobectomy with preservation of the middle lobe because of the risk of middle lobe torsion or emphysematous change. We describe a successful result following lobectomy with preservation of the middle lobe for metachronous pulmonary metastasis originating from the colon cancer in the right upper lobe after initial right lower lobectomy.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
