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Thorac Cardiovasc Surg 2013; 61(02): 138-143
DOI: 10.1055/s-0032-1311531
Original Thoracic
Georg Thieme Verlag KG Stuttgart · New York

Right Middle Lobe Transposition after Upper Lobectomy: Influence on Postoperative Pulmonary Function

Kazuhiro Ueda
1   Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
,
Toshiki Tanaka
1   Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
,
Masataro Hayashi
1   Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
,
Nobuyuki Tanaka
2   Division of Radiology, Department of Radiopathology and Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguci, Japan
,
Tao-Sheng Li
3   Department of Stem Cell Biology, Nagasaki University Graduate School of Biomedical Science, Life Science and Radiation Research, Nagasaki, Japan
,
Kimikazu Hamano
1   Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
› Author Affiliations
Further Information

Publication History

11 October 2011

04 February 2012

Publication Date:
10 October 2012 (online)

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Abstract

Background The aim of the present study was to determine the prevalence of anatomical transposition of the remaining right middle lobe after right upper lobectomy and the effect of this transposition on postoperative global pulmonary function.

Methods We correlated the postoperative pulmonary anatomical change with the functional change in patients undergoing right upper lobectomy for lung cancer. To estimate the regional pulmonary function, we measured the regional volume of the lung using normal lung attenuation values (− 600 to − 910 Hounsfield units), known as the functional lung volume, by computed tomography. The position of the middle lobe was objectively evaluated using volume-rendering three-dimensional computed tomography lung models. Intraoperatively, middle lobes were not fixed with the lower lobes.

Results Postoperatively, the middle lobe remained attached to the anterobasal segment in 24 patients, whereas it migrated cranially in the remaining 26 patients. The functional volume of the middle lobe changed by various degrees postoperatively (range: 9 to 171% of preoperative values, mean: 96 ± 34%), and this change was significantly associated with the global pulmonary function (R = 0.5, p = 0.01). However, there were no significant differences between patients with and without middle lobe migration with respect to the postoperative functional volume of the middle lobe, the postoperative functional volume of the total lung, and global pulmonary function.

Conclusion Right middle lobe transposition after upper lobectomy is not associated with the deterioration of pulmonary function, but unexpected deflation of the right middle lobe is. Strategies for preventing middle lobe deflation should be explored in the clinical setting.

Keywords

lobectomy - pulmonary function - lung cancer
 

  • References

  • 1 Ou SH, Zell JA, Ziogas A, Anton-Culver H. Prognostic factors for survival of stage I nonsmall cell lung cancer patients: a population-based analysis of 19,702 stage I patients in the California Cancer Registry from 1989 to 2003. Cancer 2007; 110 (7) 1532-1541
    CrossrefPubMedGoogle Scholar
  • 2 Ali MK, Mountain CF, Ewer MS, Johnston D, Haynie TP. Predicting loss of pulmonary function after pulmonary resection for bronchogenic carcinoma. Chest 1980; 77 (3) 337-342
    CrossrefPubMedGoogle Scholar
  • 3 Ueda K, Tanaka T, Li TS, Tanaka N, Hamano K. Quantitative computed tomography for the prediction of pulmonary function after lung cancer surgery: a simple method using simulation software. Eur J Cardiothorac Surg 2009; 35 (3) 414-418
    CrossrefPubMedGoogle Scholar
  • 4 Wu MT, Pan HB, Chiang AA , et al. Prediction of postoperative lung function in patients with lung cancer: comparison of quantitative CT with perfusion scintigraphy. AJR Am J Roentgenol 2002; 178 (3) 667-672
    CrossrefPubMedGoogle Scholar
  • 5 Lamers RJ, Thelissen GR, Kessels AG, Wouters EF, van Engelshoven JM. Chronic obstructive pulmonary disease: evaluation with spirometrically controlled CT lung densitometry. Radiology 1994; 193 (1) 109-113
    PubMedGoogle Scholar
  • 6 Kinsella M, Müller NL, Abboud RT, Morrison NJ, DyBuncio A. Quantitation of emphysema by computed tomography using a “density mask” program and correlation with pulmonary function tests. Chest 1990; 97 (2) 315-321
    CrossrefPubMedGoogle Scholar
  • 7 Uramoto H, Takenoyama M, Hanagiri T. Simple prophylactic fixation for lung torsion. Ann Thorac Surg 2010; 90 (6) 2028-2030
    CrossrefPubMedGoogle Scholar
  • 8 Higashiyama M, Takami K, Higaki N, Kodama K. Pulmonary middle lobe fixation using TachoComb in patients undergoing right upper lobectomy with complete oblique fissure. Interact Cardiovasc Thorac Surg 2004; 3 (1) 107-109
    CrossrefPubMedGoogle Scholar
  • 9 Le Pimpec-Barthes F, Arame A, Pricopi C, Riquet M. Prevention of middle lobe torsion or bronchial plication using anti-adhesive membrane: a simple, safe and uncomplicated technique!. Eur J Cardiothorac Surg 2011; 39 (6) 1059-1060
    CrossrefPubMedGoogle Scholar
  • 10 Sudoh M, Ueda K, Kaneda Y , et al. Breath-hold single-photon emission tomography and computed tomography for predicting residual pulmonary function in patients with lung cancer. J Thorac Cardiovasc Surg 2006; 131 (5) 994-1001
    CrossrefPubMedGoogle Scholar
  • 11 Yoshimoto K, Nomori H, Mori T , et al. Prediction of pulmonary function after lung lobectomy by subsegments counting, computed tomography, single photon emission computed tomography and computed tomography: a comparative study. Eur J Cardiothorac Surg 2009; 35 (3) 408-413
    CrossrefPubMedGoogle Scholar
  • 12 Ueda K, Tanaka T, Hayashi M, Li TS, Tanaka N, Hamano K. Computed tomography-defined functional lung volume after segmentectomy versus lobectomy. Eur J Cardiothorac Surg 2010; 37 (6) 1433-1437
    CrossrefPubMedGoogle Scholar
  • 13 ad hoc Statement Committee, American Thoracic Society. Mechanisms and limits of induced postnatal lung growth. Am J Respir Crit Care Med 2004; 170 (3) 319-343
    CrossrefPubMedGoogle Scholar
  • 14 Van Leuven M, Clayman JA, Snow N. Bronchial obstruction after upper lobectomy: kinked bronchus relieved by stenting. Ann Thorac Surg 1999; 68 (1) 235-237
    CrossrefPubMedGoogle Scholar
  • 15 Sundaramoorthi T, Hashim S, Dillon P, Ramachandra R, Collins FJ, Rosin MD. An unusual cause of breathlessness after lobectomy for lung cancer. Ann Thorac Surg 2004; 78 (1) e13-e14
    CrossrefPubMedGoogle Scholar
  • 16 Korst RJ, Humphrey CB. Complete lobar collapse following pulmonary lobectomy. Its incidence, predisposing factors, and clinical ramifications. Chest 1997; 111 (5) 1285-1289
    CrossrefPubMedGoogle Scholar