About Prof. Chen Haiquan
Prof. Chen Haiquan is Chief of Thoracic Surgery at Fudan University Shanghai Cancer Center, specialising in minimally invasive resection of lung cancer, oesophageal cancer, and mediastinal tumours. He is one of China's highest-volume lung cancer surgeons and, in 2023, became the only thoracic surgeon in mainland China elected as an Active Member of the American Association for Thoracic Surgery (AATS) in the general thoracic specialty. His landmark contributions include the Minimally Invasive 3.0 framework (Annals of Surgery), a selective lymph node dissection strategy cited in 17 international guidelines including NCCN, and the "curative window" theory for ground-glass nodule adenocarcinoma formalised in the 2023 Expert Consensus Guidelines on Pulmonary GGN Management.
Case Overview
Ms. Lin (pseudonym), a 43-year-old non-smoking woman, was identified on routine low-dose CT screening with a 14 mm part-solid ground-glass nodule (GGN) in the right upper lobe, solid component 4 mm. Serial CT over 18 months showed growth of the solid component to 6 mm, meeting surgical evaluation criteria. High-resolution CT confirmed a consolidation-to-tumour ratio (CTR) of 0.43, spiculated margin, and pleural tethering — features consistent with invasive or minimally invasive adenocarcinoma. Multidisciplinary review confirmed the indication for uniportal VATS right upper lobe segmentectomy (S1+2). Intraoperative frozen section confirmed minimally invasive adenocarcinoma with clear margins; selective lymph node sampling of stations 2R, 4R, and 10R was negative. The chest drain was removed at 24 hours; Ms. Lin was discharged on postoperative day two. Final pathology: pT1bN0M0, R0 resection. At two-year follow-up she remains disease-free. Ms. Lin reflected: "I was frightened when they found the nodule, and even more frightened when it grew. Prof. Chen's team explained exactly what it was, exactly what the surgery would involve, and exactly what to expect. I was home in two days. Two years later I am completely well."
Diagnostic Workup
Serial low-dose CT over 18 months documented growth of the solid component from 4 mm to 6 mm, meeting the 2023 Expert Consensus Guidelines threshold for surgical evaluation. HRCT characterised the nodule as part-solid, 14 mm, CTR 0.43, spiculated margin, pleural tethering, no satellite nodules or mediastinal lymphadenopathy — assessed against the ECTOP1008 multicentre criteria (83% diagnostic accuracy for this size range). 3D CT reconstruction planned the segmentectomy resection margins. PET-CT and bone scan were omitted per MDT protocol: the probability of distant metastasis was sufficiently low that these investigations would not alter the surgical plan. Pulmonary function testing confirmed adequate reserve for segmentectomy.
Prof. Chen's pre-operative assessment: The imaging profile — part-solid, CTR 0.43, spiculated, pleural tethering, documented solid component growth — is consistent with minimally invasive or early invasive adenocarcinoma. The size and location are ideal for segmentectomy with adequate margin and maximum parenchyma preservation. Selective lymph node sampling is appropriate: the imaging profile predicts very low probability of mediastinal nodal involvement, and systematic lymphadenectomy would add operative time and immunological cost without oncological benefit.
Treatment Strategy and Course
Diagnosis: Part-Solid GGN, Right Upper Lobe, 14 mm, incremental solid component growth over 18 months — imaging consistent with minimally invasive adenocarcinoma; resection indicated per 2023 Expert Consensus Guidelines.
Treatment principle: uniportal VATS segmentectomy with intraoperative frozen section guidance and selective lymph node sampling — complete oncological resection with maximum parenchyma preservation and minimum systemic impact.
- Preoperative planning: 3D CT reconstruction; resection margin ≥2 cm or margin-to-tumour ratio ≥1; HookWire CT-guided nodule localisation on the morning of surgery
- Uniportal VATS segmentectomy (S1+2): Single 3 cm utility incision, fourth intercostal space; intersegmental plane developed by inflation-deflation; segmental vessels and bronchus divided with endoscopic staplers
- Intraoperative frozen section: Minimally invasive adenocarcinoma, lepidic-predominant, margin clear at 2.3 cm; no conversion to lobectomy; total operative time 85 minutes
- Selective lymph node sampling: Stations 2R, 4R, 10R — all negative; systematic mediastinal lymphadenectomy not performed
- Postoperative course: Chest drain removed at 24 hours; oral analgesia from hour 12; mobilised day one; discharged postoperative day two; no complications
- Final pathology: Minimally invasive adenocarcinoma, pT1bN0M0, R0; all sampled nodes negative; no adjuvant therapy
- Two-year follow-up: No recurrence on serial low-dose CT; annual surveillance continuing
Prof. Chen's clinical reflection: The result — R0 resection, negative nodes, discharged day two, disease-free at two years — is what the Minimally Invasive 3.0 framework is designed to achieve. Incision minimal, organ preservation maximal, systemic impact minimal. The selective lymph node sampling decision was validated by pathology. Every element of the operative plan was executed as designed, and the patient went home in two days with a curative resection.
Expert Commentary — Prof. Chen Haiquan
1. The Minimally Invasive 3.0 Framework
Minimally invasive thoracic surgery has evolved through three generations. Minimally Invasive 1.0 replaced thoracotomy with VATS, reducing wound trauma. Minimally Invasive 2.0 extended this to uniportal techniques. The Minimally Invasive 3.0 framework (Annals of Surgery, 2016) adds organ minimalism — preserving maximum lung parenchyma through sublobar resection in appropriately selected patients — and systemic minimalism — reducing operative time, anaesthetic duration, and ventilation exposure. Evidence now confirms that sublobar resection in early-stage lung adenocarcinoma achieves equivalent oncological outcomes to lobectomy with superior pulmonary function preservation, contributing to the 15% improvement in five-year survival and 30% reduction in complications associated with this approach.
2. Selective Lymph Node Dissection
Systematic mediastinal lymphadenectomy has been standard in lung cancer surgery, but carries costs: prolonged operative time, disruption of mediastinal immune architecture, and added morbidity without benefit in patients with negligibly low nodal disease probability. Prof. Chen's team identified six imaging and pathological criteria — including tumour size, solid component proportion, and pathological subtype — with 100% negative predictive value for mediastinal nodal involvement. In patients meeting these criteria (in situ, minimally invasive, or lepidic-predominant adenocarcinoma ≤2 cm), selective sampling replaces systematic dissection. This strategy is incorporated into 17 international guidelines including NCCN and implemented in more than 50 tertiary hospitals in China.
3. The Curative Window Theory for GGN Adenocarcinoma
GGN lung adenocarcinoma grows slowly, metastasises late, and has a prolonged pre-invasive phase during which resection is curative. The curative window theory holds that optimal surgical timing is not at detection — which risks over-treatment — but at the point where imaging evidence of progression (solid component growth, increasing CTR, new morphological features) indicates transition to the minimally invasive or invasive phase. At this point the disease remains localised, nodal involvement is rare, and sublobar resection is curative. The 2023 Expert Consensus Guidelines operationalise this through serial CT surveillance with defined growth thresholds and morphological criteria for surgical referral.
How CMCS Shanghai Coordinated This Case
CMCS Shanghai supported Ms. Lin throughout the pathway at Fudan University Shanghai Cancer Center, including: priority consultation coordination with Prof. Chen's thoracic surgery team and the multidisciplinary tumour board; bilingual interpretation across all consultations, surgical planning, and follow-up; bilingual explanation of the GGN assessment, segmentectomy plan, selective lymph node sampling strategy, and intraoperative frozen section process; coordination of serial CT, HRCT, 3D reconstruction, pulmonary function testing, and HookWire localisation with bilingual results communication; bilingual surgical consent; postoperative ward coordination and discharge planning; final pathology communication with bilingual staging explanation; and long-term surveillance coordination.
For international patients with pulmonary nodules, ground-glass opacities, or lung cancer requiring surgical evaluation, Prof. Chen Haiquan's team at Fudan University Shanghai Cancer Center offers access to one of China's most experienced thoracic oncology programmes. CMCS ensures that expertise is accessible — in the patient's language, with every step coordinated and communicated clearly.
This case report is de-identified and published for educational purposes. All clinical details have been anonymized in accordance with patient privacy standards. CMCS Shanghai is a medical concierge service and does not provide direct medical care.
0 Kommentare