Surgical Resection of Lung Cancer in the Right Middle Lobe Associated with the Right Aortic Arch

An 82-year-old man was referred to our hospital with dyspnea and diagnosed with right middle lobe adenocarcinoma pT2bN0M0 (stage IIA). He was also diagnosed with a right aortic arch (Stewart classification Type I); however, no other congenital heart anomoly was identified. Three-dimensional computed tomography revealed that the left brachiocephalic trunk was the first branch originating from the right aortic arch, followed by the right common carotid artery and right subclavian artery, and an aortic diverticulum was detected in the descending aorta. We performed right middle lobectomy and lymph node dissection. During dissection of the mediastinal lymph nodes, we observed the right recurrent nerve encircling the right aortic arch. No postoperative complications such as recurrent nerve paralysis were observed. Surgeons performing operations for lung cancer in patients with a right aortic arch should conduct careful ex-ploration of the operative field to trace the course of the recurrent nerve and also carefully decide on the extent of dissection of the mediastinal lymph nodes. We conclude that further research is warranted to establish an optimal range of lymph node dissection in such cases.