The extended resection of the upper lobe of the right lung in oncologically reasonable limits includes the removal of the regional lymphatic apparatus receiving the lymph from this lobe. It is formed by groups of intrapulmonary, root and mediastinal lymph nodes, interconnected by lymphatic vessels.
The final decision on the acceptability and feasibility of performing extended upper lobe resection in patients with advanced stages of development of the disease is made after thoracotomy and assessing the prevalence of blastomatous changes. At the same time, it is necessary to purposefully determine the state of the lymphatic collectors of the adjacent lobes of the right lung — the middle and lower ones. The absence of metastases in the lymph nodes formed by these collectors indicates the regionality, localization of the lesion of the lymphatic collectors of the tumor-affected upper lobe. This is the basis for performing extended upper lobectomy. The spread of metastases to the lymph nodes that make up the mediastinal part of the lymphatic collector, as a rule, remains regionally long. If the damage is more extensive, i.e.other groups of lymph nodes are also involved in the blastomatous process, located nearby and connected to the regional groups of mediastinal lymph nodes — this is not a reason forrefusal of fractional resection of the lung. Then, the removal of lymph nodes and fiber of the mediastinum is expanded, including, along with regional ones, these groups of lymph nodes, as is done in right-sided pneumonectomy.
The dissection of the intrapulmonary, anterior and upper root groups of regional lymph nodes with expanded right-sided upper lobectomy with the aim of increasing the radicalism and safety of this stage of the operation begins with treating the vessels of the upper lobe, isolating and crossing the unpaired vein with a wide dissection of the mediastinal pleura above the right tracheobronchial, paratracheal and preventive lymph. knots. Then, the upper lobe bronchus, an interlobar trunk of the pulmonary artery, and the adjacent regional lymphatic collector sections of the upper lobe become adjacent. Sequentially, the upper lobe, upper interlobar, anterior and upper root groups of lymph nodes are dissected and separated from the root of the upper lobe and along the interlobar trunk of the pulmonary artery. . After the upper lobe bronchus is released, it is crossed and the upper lobe is removed. Right tracheobronchial, paratracheal and preventive lymph nodes of the mediastinum are isolated and removed. Thus, the upper mediastinosis with lymphadenectomy is completed . In the case of more common blastomatous lesions of the lymphatic collectors of the mediastinum, the volume of intervention on them should be expanded.
The lower and middle lobes of the right lung are shifted to the dome of the pleural cavity. Move down the right dome of the diaphragm. Dissect the pulmonary ligament and mediastinal pleura from the diaphragm to the lower pulmonary vein. The lower pulmonary vein is withdrawn upwards and anteriorly. From the access to the anatomical formations of the mediastinum that has been so formed, they dissect and remove the bifurcation and peri-esophageal groups of lymph nodes.
The anterior and posterior sheets of the dissected mediastinal pleura are connected along its entire length by separate interrupted sutures.