How is right lower lobe mediastinal lymphadenectomy performed?

Updated: Dec 10, 2019
  • Author: R James Koness, MD, FACS; Chief Editor: Erik D Schraga, MD  more...
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Answer

For tumors of the right lower lobe, the operating surgeon begins by standing at the back of the patient. The mediastinal pleura is opened anterior and posterior to the inferior pulmonary ligament. The esophagus is exposed from the diaphragm to the inferior pulmonary vein.

Dissection is carried out in a superior direction. The pulmonary ligament and paraesophageal (stations 9 and 8) are dissected en bloc with adjacent fatty tissue up to the inferior pulmonary vein, which is then ligated and divided.

The surgeon then moves to the front of the patient, where the esophagus is retracted posteriorly and the lung anteriorly. Dissection continues there with the lymph nodes at the bifurcation of the trachea, followed by lymph nodes along the right mainstem bronchus (stations 7 and 10).

Next, the major interlobar fissure is opened to expose the bronchovascular structures, where the inferior pulmonary artery and the lower-lobe bronchus are exposed, ligated, and divided. Dissection of the superior mediastinal lymph nodes should then be carried out as previously described.

Keep in mind that nodal metastases to the lower mediastinum from upper-lobe cancer have more frequently been observed than the lower-lobe cancer metastasizing to the upper mediastinum. [19]


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