Early postoperative complications after middle lobe-preserving surgery for secondary lung cancer

Surg Today. 2017 May;47(5):601-605. doi: 10.1007/s00595-016-1413-6. Epub 2016 Sep 14.


Purpose: Preservation of the middle lobe during lung surgery is traditionally avoided, because its presence in the hemithoracic cavity is considered a cause of complications. We report a series of lung cancer patients who underwent a secondary pulmonary resection with the preservation of the middle lobe to explore the complications and feasibility of these procedures.

Methods: We reviewed the clinical courses of six patients who underwent surgery for metachronous lung cancers. Five patients underwent right upper lobectomy, including one sleeve lobectomy, after having undergone prior right lower lobectomy. The remaining patient underwent a right lower lobectomy after having undergone a prior right upper lobectomy.

Results: There were no treatment-related deaths. One patient was readmitted for surgery to treat delayed air leakage progressing to pyothorax. One patient was treated for persistent air leakage. Two patients required intermittent drainage of pulmonary effusion, because of middle lobe atelectasis. The postoperative forced vital capacity and forced expiratory volume in 1 s were greater than the values predicted post-pneumonectomy in four evaluable patients.

Conclusions: While postoperative complications after middle lobe-preserving surgery are manageable, their high incidence should be considered when performing this surgery.

Keywords: Lung cancer surgery; Middle lobe preservation; Pulmonary function.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anastomotic Leak
  • Empyema, Pleural
  • Feasibility Studies
  • Female
  • Humans
  • Lung Neoplasms / surgery*
  • Male
  • Middle Aged
  • Organ Sparing Treatments / methods*
  • Pleural Effusion
  • Pneumonectomy / methods*
  • Postoperative Complications* / epidemiology
  • Postoperative Complications* / etiology
  • Retrospective Studies
  • Time Factors
  • Treatment Outcome