Lung Cancer Surgery | Prof. Tan Qiang (Thoracic Surgery) | CMCS Shanghai

About Prof. Tan Qiang

Prof. Tan Qiang is a thoracic surgery specialist at Shanghai Chest Hospital, affiliated with Shanghai Jiao Tong University. He focuses on minimally invasive VATS lobectomy and surgical treatment of early to mid-stage lung cancer. He is known for his precision in complex pulmonary resections.

Case Overview

A 52-year-old non-smoking woman presented with an incidentally discovered 1.8 cm mixed ground-glass opacity (mGGO) in the right upper lobe posterior segment (S2), identified on routine health screening. High-resolution CT and 3D reconstruction revealed a lesion with 30% solid component abutting the oblique and horizontal fissure junction — anatomically complex and suspicious for minimally invasive adenocarcinoma. Prof. Tan Qiang's team at Shanghai Chest Hospital performed a single-port VATS anatomical resection of Segment 2 with partial Segment 6, guided by ICG fluorescence navigation and intraoperative 3D planning. The patient was discharged on day 3 with a pain score of 2/10 and lung function preserved at 95% of preoperative baseline.

Patient Background

• Age / Sex: 52-year-old female
• Chief Complaint: Incidental right upper lobe ground-glass nodule on routine health check-up, 3 months prior
• Medical History: Non-smoker; no family history of malignancy
• Physical Exam: Clear breath sounds bilaterally; no crackles or wheeze

Pre-operative Workup

Imaging (High-Resolution CT + 3D Reconstruction)

• Location: Right upper lobe posterior segment (S2), deep, abutting the oblique-horizontal fissure junction with partial involvement of S6
• Characteristics: Mixed GGO (mGGO), 1.8 cm × 1.5 cm; solid component ~30% — consistent with minimally invasive adenocarcinoma (MIA)
• Vascular Anatomy: 3D-CTA reconstruction identified a variant posterior segmental vein (V2) crossing anterior to the nodule, and a large intersegmental vein requiring preservation
• Lymph Nodes: No mediastinal or hilar enlargement (cN0)

Pulmonary Function

• FEV1: 92% of predicted
• DLCO: Normal

Clinical Stage: cT1bN0M0 (Stage IA2)

Diagnosis & Surgical Strategy

Diagnosis: Right upper lobe ground-glass nodule; early lung adenocarcinoma.

Procedure: Single-port VATS anatomical resection of Segment 2 with partial Segment 6 + systematic lymph node dissection.

Rationale

• Oncological Principle: Despite the small size, the 30% solid component mandated anatomical segmentectomy over wedge resection to ensure adequate margins (>2 cm or >nodule diameter) and systematic nodal clearance
• Functional Preservation: The patient was young and declined lobectomy. S2 + partial S6 resection achieved oncological adequacy while preserving Segments S1 (apical) and S3 (anterior) — maximizing long-term respiratory function
• Minimally Invasive Advantage: Single-port VATS minimizes intercostal nerve compression, reduces post-operative pain, and aligns with ERAS (Enhanced Recovery After Surgery) principles

Anticipated Technical Challenges

• Deep nodule localization in a non-palpable lesion
• Intersegmental plane identification in a complex fissure anatomy
• Variant vascular anatomy requiring precise dissection to avoid injury to adjacent segments

Operative Procedure

• Position & Access: Left lateral decubitus; single 3–4 cm utility port at the right 4th intercostal space, anterior axillary line; no rib spreader used
• Exploration & Localization: Full thoracoscopic exploration — no adhesions; intraoperative ultrasound combined with preoperative 3D reconstruction used to confirm deep nodule location (no hook-wire or methylene blue required given stable anatomical position)

Vascular Dissection — Vessel-First Strategy

• Prof. Tan employed a superficial-to-deep, vessel-first approach
• V2 (posterior segmental vein) branches divided; intersegmental vein preserved
• A2 (posterior segmental artery) sub-branches meticulously dissected; clipped with Hem-o-lok and divided without injury to adjacent S1 or S6 vessels

Bronchial Division

• B2 (posterior segmental bronchus) exposed; inflation-deflation test confirmed segmental boundary
• B2 divided with Endo-GIA stapler; intraoperative frozen section of bronchial margin — negative

Intersegmental Plane Division — ICG Fluorescence Navigation

• Intersegmental vein used as anatomical landmark under inflation
• Intravenous ICG injected; S2 segment displayed negative staining (dark) due to interrupted portal flow; S1 and S6 displayed positive fluorescence (green) — providing a real-time, sub-segmental precision boundary for parenchymal division
• Electrocautery hook and ultrasonic scalpel used along the fluorescence boundary to complete the intersegmental plane

Lymph Node Dissection

• Systematic dissection of stations 2R, 4R, 7, 10, and 11 — 18 nodes retrieved

Specimen Retrieval

• Specimen placed in retrieval bag; extracted via the single utility port

Operative Data

• Operative Time: 120 minutes
• Estimated Blood Loss: <50 mL
• Lymph Nodes Retrieved: 18 (all negative)

Pathology & Post-operative Recovery

Pathology Report

• Gross: Grey-white nodule, 1.6 cm, firm
• Histology: Invasive lung adenocarcinoma, acinar-predominant subtype; surgical margins negative (R0)
• Pathological Stage: pT1bN0M0 (Stage IA2)

Post-operative Course (ERAS Protocol)

• Tubeless Approach: No urinary catheter placed; single small-bore chest drain only
• Day 1: Chest drain removed; ambulating; tolerating sips of water
• Day 3: Chest X-ray confirmed full lung re-expansion, no air leak; discharged
• Pain Score (VAS): Average 2/10 — markedly lower than open thoracotomy (6–8/10)

Follow-up & Adjuvant Treatment

• Molecular Testing: EGFR, ALK, ROS1 — all negative
• Adjuvant Therapy: Given Stage IA2 with no high-risk features (no poor differentiation, no lymphovascular invasion), Prof. Tan recommended surveillance only — no adjuvant chemotherapy or targeted therapy
• 1 Month Post-op: Repeat pulmonary function testing showed FEV1 decline of only 5% — essentially preserved baseline; quality of life fully restored

Expert Commentary — Prof. Tan Qiang

1. Single-Port VATS — The Pinnacle of Minimally Invasive Thoracic Surgery

Single-port VATS demands a level of instrument coordination and spatial awareness that multi-port approaches do not. Working through a single 3–4 cm incision, we completed meticulous vascular dissection, bronchial division, and intersegmental plane development in a confined operative field. The reward is tangible: minimal intercostal nerve trauma, a pain score of 2 out of 10, and a patient who walked out of hospital on day 3. This is what ERAS looks like in thoracic surgery — not a protocol on paper, but a lived outcome for the patient.

2. Precision Anatomy and Functional Preservation

The conventional view that GGO nodules under 2 cm can be managed with wedge resection is increasingly outdated. When solid component exceeds 25–30%, the oncological argument for anatomical segmentectomy is clear: portal-territory clearance of potential microsatellite disease and reliable margin geometry. In this case, 3D preoperative planning and ICG fluorescence navigation allowed us to operate at a sub-segmental level — sculpting the resection boundary rather than approximating it. The result was R0 resection with 95% lung function preserved. That is the standard we hold ourselves to.

3. Systematic Lymph Node Dissection — Non-negotiable Even in Early Disease

Minimally invasive surgery must never mean oncologically compromised surgery. Systematic lymph node dissection is not optional in lung cancer, regardless of clinical stage. Accurate pathological staging directly determines whether adjuvant therapy is indicated and shapes the patient's long-term surveillance plan. Retrieving 18 nodes through a single port is technically demanding — but it is the standard of care, and it is what our patients deserve.

How CMCS Shanghai Coordinated This Case

China Medical Concierge Shanghai (CMCS) supported this patient's care pathway from initial overseas inquiry through discharge and follow-up planning. Our coordination included:

• Pre-arrival CT image review and specialist referral to Prof. Tan Qiang's thoracic surgery team at Shanghai Chest Hospital
• Arrangement of high-resolution CT, 3D reconstruction, and pulmonary function testing
• Bilingual interpretation during pre-operative consultation and surgical consent
• Surgical admission logistics, including hospital registration and accommodation support for accompanying family
• On-site medical interpretation throughout the hospitalization
• Post-discharge coordination of molecular testing results, follow-up imaging scheduling, and remote check-in at one month

For international patients navigating an early lung cancer diagnosis abroad, the combination of medical uncertainty and logistical complexity can be paralyzing. CMCS exists to remove that barrier — connecting patients with China's leading thoracic surgeons while ensuring every clinical detail is understood and every step is managed.

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.