Stage IA bronchioloalveolar carcinoma: complete resection with thoracoscopic segmentectomy

What happened, in summary

This 69-year-old woman was admitted for diagnosis and treatment of a growing 12 mm lung nodule. She had never smoked and had mitral valve insufficiency treated with oral medication. Physical examination, routine laboratory tests, coagulation studies, liver and kidney function tests, and serum cancer antigens were within normal limits. Pulmonary function was good. CT showed a partially serrated 12 mm nodule in the anterior basal segment of the right lower lobe, called RS8. Bronchoscopy did not provide a diagnosis, so thoracoscopic surgery was planned. Before surgery, the team used three-dimensional CT to map the lung vessels and simulate the safest segmentectomy approach. CT-guided needle marking was also performed the day before surgery to help localize the small lesion. The operative plan was VATS needle biopsy first, followed by total thoracoscopic segmentectomy of RS8 if frozen section confirmed malignancy. During surgery, frozen section did confirm bronchioloalveolar carcinoma. Surgeons performed RS8 segmentectomy with node dissection, dividing the A8 artery and B8 bronchus, using intersegmental veins and inflation-deflation lines to guide the resection plane. Air leaks were repaired with sutures, absorbable pledgets, polyglycolic acid sheets, and fibrin glue. Operative time was 221 minutes, and blood loss was 30 mL. The chest tube was removed on postoperative day 2, and she went home on postoperative day 5 without complications. Final pathology showed T1aN0M0 bronchioloalveolar carcinoma, with a 15 mm tumor-free surgical margin. The case demonstrates a lung-sparing approach for a small peripheral tumor, using preoperative 3D mapping and intraoperative frozen section to support complete segmental resection.