Middle lobe preservation and fixation: right upper and lower sleeve bilobectomy. How to do it

Moriyama, Satoru; Yano, Motoki; Sasaki, Hidefumi; Hikosaka, Yu; Yokota, Keisuke; Fujii, Yoshitaka

doi:10.1007/s00595-012-0143-7

Cited by 9 publications

(4 citation statements)

References 9 publications

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“…In this case, there was not only a caliber mismatch but severe tension at the anastomosis site between the right main and middle bronchi. Moriyama and colleagues (15) reported a case of right upper and lower sleeve bilobectomy. They anastomosed the right main and middle bronchi without addressing the proximal stump.…”

Section: Discussionmentioning

confidence: 99%

Influence of caliber mismatch on patients’ clinical course after sleeve lobectomy

Tsukioka

Izumi

Komatsu

et al. 2021

Gen Thorac Cardiovasc Surg

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Objective Respiratory complications are critical events after sleeve lobectomy. A caliber mismatch is an important factor in wound healing at the anastomotic site. This study aimed to determine the influence of caliber mismatches on patients' clinical courses after sleeve lobectomy. MethodsWe investigated the clinical courses of 56 patients with primary lung cancer who underwent pulmonary resection with end-to-end bronchoplasty. Anastomoses between the main bronchus and the segmental, right upper or middle bronchus, and between the trunks intermedius and the segmental or middle bronchus are categorized as an "anastomosis with caliber mismatch". ResultsAmong the 56 patients, 22 underwent bronchoplasty with caliber mismatch. There were no in-hospital deaths, and the mortality rates at the 30-and 90-day evaluations were zero.Respiratory complications (n = 10, 52%, p = 0.005), such as pneumonia (n = 7, 32%, p = 0.029), retention of pleural effusion (n = 6, 27%, p = 0.026) and bronchopleural fistula (n = 3, 14%, p = 0.027), were significantly increased after bronchoplasty with caliber mismatch. Lower body mass index (BMI) is a significant risk factor for respiratory complications after sleeve lobectomy with caliber mismatch (median value; 23.2 vs 21.2, p = 0.036).Conclusions Significant respiratory complications are apparent after bronchoplasty with caliber mismatch, especially patients with low BMI have a high risk of respiratory complications.Appropriate patient selection and cautious perioperative management are mandatory for this type of lung-preserving surgery.

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Section: Discussionmentioning

confidence: 99%

Influence of caliber mismatch on patients’ clinical course after sleeve lobectomy

Tsukioka

Izumi

Komatsu

et al. 2021

Gen Thorac Cardiovasc Surg

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“…To prevent such torsion in the present case, the middle lobe adhesions to the chest wall were not removed, and this prevented the residual middle lobe from becoming twisted. In case without such adhesions, Moriyama and colleagues suggested placement of a latissimus dorsi flap through the intercostal space diagonally in the thoracic cavity and fixation of the preserved middle lobe with the flap to prevent postoperative torsion [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

A case report: right upper lobectomy with middle lobe preservation after right lower lobectomy

et al. 2015

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Few reports have described right upper and lower lobectomy with preservation of the middle lobe because of the risk of middle lobe torsion or emphysematous change. Herein we describe a successful result following lobectomy with preservation of the middle lobe for metachronous pulmonary metastasis originating from colon cancer in the right upper lobe after initial right lower lobectomy. A 69-year-old man who had undergone right lower lobectomy for pulmonary metastasis originating from colon cancer 3 years earlier was diagnosed as having suspected metachronous pulmonary metastasis in the right upper lobe. Because preoperative computed tomography (CT) indicated that the distance between the tumor and the entrance of the upper bronchus was 20 mm, it was considered difficult to achieve complete resection by a wedge resection or segmentectomy. Furthermore, preoperative CT demonstrated compensatory hypertrophy of the middle lobe and elevation of the right diaphragm, thus reducing the size of the thorax. Therefore, right upper lobectomy with middle lobe preservation was planned. The operation was performed using a totally thoracoscopic approach. Adhesion of the upper lobe to the chest wall was easily detached. As the middle lobe adhered to the chest wall, this served to prevent middle lobe torsion. The fissure between the upper and middle lobes had fused because of adhesion resulting from the initial lower lobectomy. Therefore, an ‘anterior fissureless approach’ was adopted to avoid any postoperative air leakage. There were no intraoperative problems, and the postoperative course was uneventful. The patient was discharged on postoperative day 6. Pathological examination of the specimen confirmed that the tumor was a metachronous pulmonary metastasis originating from the colon cancer. Four months after the operation, he had no requirement for additional oxygen support, and postoperative CT demonstrated a sufficiently expanded residual middle lobe without emphysematous change.

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“…To avoid such a critical complication, the following measures were undertaken: fixation of the hilar stalk by ligating a transposed muscle flap to the bronchial stump. In a previously reported case [4], a latissimus dorsi flap was utilized to prevent such torsion. Because there are few reports of middle lobe preserving right upper and lower bilobectomy, the most efficient way of stabilizing a preserved middle lobe remains controversial.…”

Section: Case Reportmentioning

confidence: 99%

Middle lobe preserving right lower lobectomy with a serratus anterior hammock flap in a patient with previous right upper lobectomy

Abe

Takahashi

Nakagawa³

et al. 2015

Interact CardioVasc Thorac Surg

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Increasingly, many patients are diagnosed with a second lung cancer after curative thoracotomy. It is very difficult to manage such patients surgically due to the significant loss of pulmonary function. Especially on the right side, avoiding a completion pneumonectomy may contribute to reducing postoperative functional loss and surgical complications as well as the morbidity of post-pneumonectomy syndrome. A technique is needed to prevent torsion of the preserved middle lobe. Following recently published cases utilizing a latissimus dorsi muscle flap, in this case report, we describe the use of the serratus anterior muscle flap as an alternative.

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Middle lobe preservation and fixation: right upper and lower sleeve bilobectomy. How to do it

Cited by 9 publications

References 9 publications

Influence of caliber mismatch on patients’ clinical course after sleeve lobectomy

Influence of caliber mismatch on patients’ clinical course after sleeve lobectomy

A case report: right upper lobectomy with middle lobe preservation after right lower lobectomy

Middle lobe preserving right lower lobectomy with a serratus anterior hammock flap in a patient with previous right upper lobectomy

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