Stage 1 lung adenocarcinoma: no recurrence after 2 years

What happened, in summary

A 57-year-old non-smoking woman with situs inversus totalis visited the hospital in May 2022 because of a persistent cough lasting 3 months. CT showed an irregular solid tumor measuring 35 x 25 mm in the peripheral pleural area of the left middle lobe and a separate 5 mm solid nodule in the left upper lobe. CT-guided percutaneous lung biopsy confirmed adenocarcinoma, staged clinically as cT2aN0M0, Stage IB. Workup found no swollen mediastinal or hilar lymph nodes and no distant metastatic lesions. PET/CT showed FDG uptake in the left middle-lobe tumor. Because situs inversus totalis mirrored her thoracic anatomy, the team used preoperative 3D-CT bronchography and angiography to plan the operation and identify vascular and airway anatomy safely. Surgery was performed through a single 3 cm uniportal video-assisted thoracoscopic incision. The team removed the left middle lobe and also performed wedge resection of the small upper-lobe nodule. Thoracic lymph nodes 2-4 and 11 were sampled. The operation lasted 125 minutes with about 50 mL of blood loss. Her chest tube was removed on postoperative day 3, and she went home on day 4 without complications. Final pathology showed a 4.0 x 3.0 x 1.8 cm adenocarcinoma in the left middle lobe, with negative surgical margin, negative visceral pleura, and negative lymph nodes. The upper-lobe nodule was not cancer; it was chronic inflammation with collagenization. Chest CT follow-up showed no recurrence or complications 2 years after surgery. Intraoperatively, the left chest anatomy matched the mirror-image preoperative plan, including a three-lobed left lung and right-sided-type arrangement of major vessels.