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.