How is left 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

When a left lower lobectomy is performed in patients with left-lower-lobe cancer, the surgeon stands to the front of the patient. The inferior pulmonary ligament is released; the pulmonary and paraesophageal lymph nodes (stations 9 and 8) are procured.

Superiorly, the inferior pulmonary vein is identified, ligated, and divided. The lung and trachea are moved anteriorly, and subcarinal and hilar lymph nodes (stations 7 and 10) are dissected away. The mediastinal lymph node dissection is completed by removing lymph nodes from the subaortic and para-aortic regions (stations 5 and 6). The oblique fissure is opened and the interlobar nodes (station 11) are included with the removal of the lower lobe.

The lower lobectomy is completed with ligation and division of the inferior pulmonary artery and division and closure of the bronchus. Usually, no formal node dissection above the aortic arch is carried out, except when enlarged or palpable nodes are noted on exploration. Division of the ligamentum arteriosum is not necessary.


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