Stage IA1 lung adenocarcinoma: disease-free after VATS right lower lobectomy

What happened, in summary

A 76-year-old man was referred for evaluation after an abnormal shadow appeared on chest radiography. CT showed a part-solid ground-glass opacity in segment 10 of the right lower lobe, measuring 18 mm overall with an 8 mm solid component, and the lesion had grown slowly over time. FDG PET-CT and brain MRI showed no distant metastasis, so the lesion was clinically diagnosed as primary right lower-lobe lung cancer, cT1aN0M0, Stage IA1. Surgical planning was complicated by anatomy: contrast-enhanced CT could not be used because he had an allergy to iodinated contrast, and high-resolution CT showed an aberrant right anterior truncal basal pulmonary artery arising from the right main pulmonary artery and coursing near the upper pulmonary vein and middle-lobe bronchus. He underwent five-port video-assisted thoracoscopic surgery. The team first performed wedge resection, and frozen section confirmed lung adenocarcinoma. Because the tumor received blood supply from both mediastinal and interlobar pulmonary arteries, limited basal segmentectomy was judged inappropriate. A right lower lobectomy was then performed, including division of the right lower-lobe bronchus, inferior pulmonary vein, and aberrant basal pulmonary artery branch, followed by systematic mediastinal lymph node dissection. Surgery lasted 157 minutes, with 60 mL blood loss. His postoperative course was uneventful; the chest drain was removed on day 5, and he was discharged on day 7. Final pathology showed adenocarcinoma, pT1aN0M0, Stage IA1, with no lymph-node metastases. At 1 year, he remained disease-free. Recognizing the anomalous artery before and during surgery helped avoid vascular injury and supported safe completion of lobectomy.