A case of central lung cancer in the lower lobe of the right lung “right middle and lower lobe resection + systemic lymph node dissection” was recently completed successfully under total lumpectomy in our hospital. The case is reported as follows. The patient, male, 60 years old, presented to the hospital with irritating dry cough with sputum and blood for 4 months, and was found to have a central right lower lobe lung occupancy with multiple nodular lesions in the lower lobe and enlarged and fused 11i lymph nodes, with loss of bronchial and pulmonary artery space in the lower and middle lobes. Fiberoptic bronchoscopy revealed: tumors were seen at the openings of B7 and 8 in the lower lobe of the right lung, and no abnormalities were seen in the remaining lobes and bronchial segments. Bronchoscopic pathological examination: hypofractionated squamous carcinoma. Preoperative examination was completed, and no distant metastases to the cranial, hepatic, renal, adrenal, bone and other organs were seen, and there were no contraindications to surgery. The patient had diabetes mellitus and actively controlled blood sugar. Pulmonary function: absolute FEV1 value 1.89 L, FEV1 percentage 66.8%, applying Juhl’s formula, the patient was able to tolerate lower middle lobe resection [1]. Preoperative discussion: the diagnosis of central lung cancer in the right lower lobe was clear, and the clinical stage was c-T3N1M0 according to the new 2009 UICC international TNM staging criteria for lung cancer [2]. right lower middle lobe resection + systemic lymph node dissection was performed under total lumpectomy on February 23, 2012. General anesthesia, double-lumen tracheal intubation, left 90* prone position, right upper limb suspension. The tumor was located at the opening of the lower lobe bronchus, 5*4*4 cm in size, without pleural depression, with hard and enlarged lymph nodes under the ramus, hilum and group 11i, and the gap with the above mentioned structures disappeared. The pulmonary veins appeared to have cancerous thrombi, and the horizontal and oblique fissures were underdeveloped at both the upper and lower ends. , moving the middle lobe out of the chest cavity. Then, each branch of the basal segment artery of the right lower lobe of the lung and the dorsal segment artery were ligated proximally with double 7-gauge silk wire branch by branch and distal ultrasonic knife dissection. Finally, the right middle bronchus was cut at 0.5 cm from the inferior border of the upper lobe bronchus by applying a linear cutting suture. The lower lobe was moved out of the chest cavity, and the upper and lower chest tubes were left in place after water testing without air leakage. The patient recovered smoothly after the operation, with I~II degree air leak, and was given 50% glucose 100ml chest perfusion on the 7th postoperative day, and the air leak stopped in the afternoon of the same day. After 2 days of observation, there was no air leakage again, and the drainage flow was less than 50 ml, and the upper and lower chest tubes were removed. Postoperative paraffin section pathology: central type hypofractionated squamous carcinoma in the lower lobe of the right lung, metastases were seen in group 7 and 11i lymph nodes. Pathological stage: P-T3N2M0, stage IIIA. He was discharged on the 10th postoperative day. 2 , Discussion Lung cancer is one of the malignant tumors that seriously endanger human health, and it is also the cancer with the highest incidence and mortality rate worldwide at present [4]. Lung cancer is also known as bronchial lung cancer. Clinical, imaging and pathologists advocate the classification of lung cancer into two major types, central and peripheral, according to general custom. Any tumor occurring above the opening of the common bronchus and lobar bronchus or segmental bronchus is designated as central type lung cancer; those occurring below the opening of segmental bronchus are designated as peripheral type lung cancer. Treatment for central lung cancer includes double lobectomy, total pneumonectomy and lobectomy. The scope of surgical resection should follow the principle of “two maxima”, i.e., maximum tumor removal and maximum preservation of healthy lung tissue [5]. Only complete resection of the tumor is possible to achieve a true cure and prolong survival. The traditional surgical approach is open thoracotomy with a posterior lateral incision, which is a long incision, traumatic, with significant postoperative pain and slow recovery. There is no definite conclusion on the suitability of thoracoscopic surgery for such cases, but it is technically feasible and the long-term results are yet to be observed in more cases. Newly published bulk case-control studies and meta-analyses internationally, as well as systematic review studies, have confirmed that thoracoscopic lobectomy significantly reduces surgical complications compared with conventional open-heart surgery [6]. In the present case, right middle and lower lung lobectomy and systemic lymph node dissection were completed under total lumpectomy, which is consistent with the concept of double lobectomy done under conventional posterior posterolateral incision. It only differs from it in the surgical sequence and pathway. Firstly, by clearing the mediastinal lymph nodes, on the one hand, the surgical field is particularly clear because there is no bleeding, and on the other hand, the bronchi are not disconnected to facilitate traction, which can better reveal the augmentation and other places; secondly, after the one-way resection of the middle lobe, the interlobular arteries and intermediate bronchi are better revealed; the blind operation under the lymph nodes via incomplete lung fissures and encapsulated adhesions and the resulting risk of major bleeding are avoided. The author believes that with the continuous development of thoracoscopic techniques and the summary of technical details, more and more patients with central lung cancer will benefit from total lumpectomy lobectomy.