Right video-assisted thoracoscopic surgery subsuperior segmentectomy after right upper lobectomy: a case report

Background: Lesions are occasionally encountered in the subsuperior segment (S*), a subsegment located between S6 and S10. Performing S* segmentectomy with a minimally invasive approach remains difficult as well as repeated pulmonary segmentectomy following ipsilateral anatomical pulmonary resection. Preoperative simulation using three-dimensional computed tomography (CT) and structure visualization is important to understand anatomical structures. Here, we report the first case of right S* segmentectomy following ipsilateral anatomical pulmonary resection. Case Description: A 71-year-old male patient reported a history of right upper lobectomy for lung cancer and chemoradiation therapy for mesopharyngeal cancer. He had a history of chronic obstructive pulmonary disease, and his preoperative forced expiratory volume in 1 s was 59.1%. A CT scan detected a right pulmonary solid nodule (1 cm) enlargement in the S* segment. Positron emission tomography-CT revealed a maximum standardized uptake value of 3.3, consistent with a lung nodule. He was suspected to be metastatic lung cancer from either the lung or mesopharyngeal cancer. For both diagnosis and treatment, he was scheduled and successfully performed for video-assisted thoracoscopic surgery (VATS) right S* segmentectomy to identify the subsequent treatment based on tumor histology. The postoperative course was uneventful. Pathological examination revealed a metachronous primary pulmonary adenocarcinoma nodule. He had no recurrence 1 year postoperatively. Conclusions: The successful management of this case highlights the potential of VATS S* segmentectomy as a viable option for patients despite previous anatomical resections. Additionally, it indicates the importance of preoperative simulations and readiness for intraoperative procedural adjustments to ensure patient safety and optimal outcomes.