Performing bilobectomy for cancer in advanced stages of development of the disease in oncologically expedient limits provides for the removal, together with the affected lung lobes, of their regional lymphatic collectors.
Studies conducted in this direction in the clinic allowed us to establish with high confidence the limits of intervention in the regional lymphatic system of the right lung for each of the options for such an operation: removal of the upper and middle lobe or lower and middle.
In the intrapulmonary part of the regional lymphatic collectors, not only groups of lymph nodes that receive lymph from resected lobes of the lung are subject to preparation and removal, but also from the lobe that remains. Limbs include interlobar lymph nodes, grouping along the interlobar vein of the left lung lobe, and also located at the base of its bronchus, i.e. respectively, upper lobe or lower lobe.
Within the limits of the anatomical formations of the root of the right lung, the lymph nodes of the anterior, upper, lower and posterior root groups are subject to dissection and removal. In the mediastinal part of the regional lymphatic collector of the right lung, the lymph nodes and the mediastinal cellulose, when performing each of the bilobectomy variants, are dissected and removed over a wide range – corresponding to those established for right-side pneumonectomy.
When performing bilobectomy, regional lymph nodes located within the upper and middle lung lobes do not require special preparation, since they are removed along with them. Access to the intrapulmonary lymph nodes receiving the lymph from the lower lobe, as well as the lower interlobar, is provided by the division of the lung along the interlobar fissure. Then the preparation and removal of a group of lymph nodes located along the interlobar vein, along the interlobar arterial trunk and in the inferior artery are available. From this access, a group of lymph nodes along the intermediate bronchus and located in the bronchus of the lower lobe can be well prepared. Often, a separate group can be represented lymph nodes in the bronchus of the upper segment of the lower lobe.
After removal of the upper and middle lobes, isolation, ligation and intersection of the unpaired vein are performed. Dissect throughout the mediastinal pleura. This provides access for preparation and removal of the front, upper and lower root lymph nodes. Most often, the allocation of these groups of regional lymph nodes continues above — in the mediastinum, moving to the preparation of the right tracheobronchial, paratracheal and prevenal lymph nodes. The mediastinal stage of the extended upper bilobectomy is completed by removing the bifurcation and peri-esophageal groups of lymph nodes .
When performing lower bilobectomy, intervention on regional lymphatic collectors within the intrapulmonary part includes removal of the upper interlobar, upper lobe , as well as groups of lymph nodes located along the interlobar arterial trunk and intermediate bronchus. Interlobar lymph nodes are isolated and shifted to the removed lobes of the right lung in the process of formation of the intermediate bronchus stump, which is located at the level of the upper lobe. The removal of these groups of lymph nodes is notably facilitated by prior selection, ligation, and intersection of the unpaired vein at the beginning of the lung resection, immediately after taking about the extent of the surgical procedure — the lower bilobectomy.
Upper lobe groups of lymph nodes — regional for the lung lobe left — are most easily isolated and removed along with the front and upper lobes
root groups of nodes. In the midstream, at first, the bifurcation and perioesophageal groups of lymph nodes are isolated and then the upstream: right tracheobronchial, paratrae , and prevenal .