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Vol.49 No.4 contents | Japanese/English |
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- Case Report -
An Octogenarian Case of Multiple Primary Lung Cancers Undergoing Right Upper Lobectomy After Right Lower Lobectomy with Preservation of the Middle Lobe
Kazuhiko Kataoka1, Toshiya Fujiwara1, Motoki Matsuura1, Noritomo Seno11Department of Thoracic Surgery, Hiroshima City Hospital, Japan
Background. Reports of right upper and lower lobectomy with preservation of the middle lobe are rare. Case. Abnormal shadows on chest X-ray film were found in an 89-year-old man on a medical examination. Chest CT scan revealed an irregularly shaped mass in the right lower lobe and a trabecular shadow in the right upper lobe. Bronchoscopy revealed the tumor in the right lower lobe bronchus. The biopsy of the tumor yielded a diagnosis of squamous cell carcinoma. The trabecular shadow of the upper lobe was suspected to be an inflammation. Video-assisted right lower lobectomy with lymph node dissection was performed. Postoperative pathological staging was pT1N2M0 p0d0E0pm0 stage IIIA. Nine months after the operation, he had lumbago, and 18F-fluorodeoxyglucose (FDG)-PET and CT were performed. On the thoracic CT, the shadow of the right upper lobe was enlarged. The standardized uptake value (SUV) of the lesion was 2.92, and lung cancer was suspected. Right upper lobectomy should be performed by postero-lateral thoracotomy. Adhesion of the middle lobe to the chest wall was not dissected to prevent the postoperative middle lobe torsion. Pathological findings of the resected specimen revealed adenocarcinoma of pT2N0M0, stage IB. Atelectasis of the middle lobe due to sputum was a postoperative complication, and aspiration via the bronchoscope was needed 3 times. Thirty months after the operation, he is alive without recurrence of the cancer. On the chest X-ray film and CT, the middle lobe has no emphysematous change, and he has only mild deformity of the thorax and mediastinal deviation. On perfusion scintigraphy, the middle lobe shows 12% of residual respiratory function. Conclusion. The operation of right upper lobectomy after the right lower lobectomy with preservation of the middle lobe is possible. The middle lobe is thought to have function and is worth preserving.
key words: Right upper and lower lobectomy, Multiple lung cancers, Postoperative lobar torsion, 18F-fluorodeoxyglucose (FDG)-PET
Received: February 9, 2009
Accepted: March 30, 2009
JJLC 49 (4): 472-476, 2009
