Oncological feasibility of performing in patients with advanced stage of cancer partial resection — extended left-sided upper lobectomy — is finally determined after thoracotomy. For this make sure in the absence of a tumor lesion outside the regional for the upper lobe of the intrapulmonary lymphatic collector.
The upper lobe affected by the tumor is separated along the interlobar fissure. From this access, the interlobar lymph nodes are prepaired and examined, especially grouped here in the lower pulmonary vein and in the bronchus of the lower lobe. The absence of cancer metastases in them gives reason to undertake an extended resection of the upper lobe.
Allocate, ligate and cross the superior pulmonary vein. Consistently isolate and cross the arteries to the segments of the upper lobe. Then the dissection of the lymph nodes of the upper lobe group becomes available — adjacent to the bronchus of the upper lobe. They are separated and shifted to the resectable lobe. This is achieved by the possibility of inspection, selection, flashing and crossing the upper lobe bronchus.
After removal of the upper lobe, the mediastinal pleura is dissected upward to the dome of the pleural cavity. Allocate and cross the arterial ligament. Otkulti upper lobe bronchus in the direction of the trachea, on the anterior-upper surface of the left main bronchus prepara the front and upper groups of root lymph nodes. Without a clear boundary, they pass into the left tracheobronchial and paratracheal. The next step is selected fiber with regional lymph nodes is separated from the lower surface of the aortic arch and in the direction of its front wall to the base of the left carotid and subclavian arteries. Fully isolated groups of lymph nodes — left paratracheal, tracheobronchial, and pre-orthocrotic — are removed. This completes the upper mediastinotomy with lymphadenectomy.
If cancer of the distant lymph nodes is affected by metastases, lymphadenectomy is also undertaken in the lower mediastinum. This is necessary due to the high probability of the spread of tumor metastases with retrograde lymph flow.
The lower lobe of the left lung is shifted to the dome of the pleural cavity and several anteriorly. the heart is gently diverted to the right. Dissect the pulmonary ligament and mediastinal pleura from the lower pulmonary vein to the diaphragm. From this access, the cellulose tissue from the lower root, bifurcation and perioesophageal groups of lymph nodes is prepared. Anatomical landmarks when performing this phase of the operation are: the lower surface of the inferior and main bronchi, the trachea bifurcation and the initial part of the right main bronchus, the anterior surface of the esophagus. Complete removal of the lymph nodes and tissue of the mediastinum by imposing nodal stitches on the sheets of the mediastinal pleura.