It is not often possible to remove the middle lobe from the lymph nodes and fiber of the mediastinum in lung cancer in advanced stages of the disease. Such a possibility appears in case of a peripheral tumor or a small central cancer of the middle lobe bronchus with predominantly endobronchial growth, which metastasizes to the lymph nodes of the mediastinum.
The peculiarity of the extended mid-lobe resection is determined by the peculiarity of the lymphogenous spread of the tumor and the condition of the regional lymphatic apparatus of the right lung by this time. The earliest, first metastases of cancer affect groups of lymph nodes, which are located at the base of the mid-lobe bronchus, as well as the upper and lower interlobar. Further, within the root of the lung, metastasis of cancer of the middle lobe is localized mainly in the anterior, upper and lower root lymph nodes. In the blastomatous process, the right tracheobronchial, paratracheal and bifurcation groups of lymph nodes are involved in the pancreas.
After thoracotomy to clarify the amount of resection, the possibility and oncological justification of performing the extended operation — removal of the middle lobe with regional lymphatic collectors, it is necessary to establish the extent of their damage. Metastasis beyond the regional lymphatic collector of the middle lobe throughout its intrapulmonary part makes removal of the middle lobe not radical.
First perform the selection of the average share of the main and additional interlobar cracks. Allocate and cross the middle lobe vein. After dissection and separation of the vein stump, interlobar lymph nodes and groups of lymph nodes located near the upper lobe and lower lobe bronchi are available for examination. The absence of tumor metastases in them gives reason to undertake an extended resection of the middle lobe.
Allocate and stitch the middle lobe bronchus and the middle lobe artery located below or slightly above it. After removal of the middle lobe proceed to the preparation of regional lymph nodes.
Within the lung, the excretion of lymph nodes is performed in the upward direction — along the intermediate bronchus to the base of the upper lobe and then along the front surface of the main bronchus. At the bottom, a chain of lower interlobar lymph nodes is dissected, which, without a clear border, pass over and merge with the lower root.
The next stage of the extended resection of the middle lobe is the removal of lymph nodes and the mediastinal tissue. After removal of the outside, under the mediastinal pleura, an unpaired vein is clearly visible. Edematize, tie up and cross. The central stump (in the superior vena cava) is attached with a hemostat and with the help of it the upper vena cava is removed. Widely dissect the mediastinal pleura from the root of the lung to the dome of the pleura. Anterior and upper root groups of lymph nodes, right tracheobronchial and paratracheal become available to the preparation. Surrounding
their fiber is isolated and removed . After completion of this phase of the operation, the upper and lower lobes of the lung are retracted.
up and forward. Separate the pulmonary ligament and dissect the mediastinal pleura. In the course of the bronchus of the lower lobe, along the lower surface of the main bronchus of the right lung, fiber is secreted with inferior, lower root and bifurcation lymph nodes. A single block with them or separately isolate and remove the mediastinal lymph nodes of the peri-esophageal group.Complete removal of the regional lymph nodes of the mediastinum by suturing the mediastinal pleura.