- (1)When a tumor involves the fissure such that R0 resection would require resection of both lobes (ie, when a wedge or segment resection is not possible for the nondominant lesion).
- (2)T4 disease, when 2 distinct tumor nodules are located in 2 separate lobes and there is no N3-category disease or persistent N2-category disease after neoadjuvant treatment (stage IIIA).
- (3)Central tumors located in the right lower lobe or right middle lobe bronchus such that a negative bronchial margin would require resection of both middle and lower lobes and a sleeve resection is not an option.
- (1)If a tumor is located in the proximal bronchus intermedius or hilum, such that a bilobectomy would not yield a negative margin, a pneumonectomy should be considered (as long as the patient has adequate pulmonary function tests to tolerate a pneumonectomy).
- (2)Patients with marginal lung function should be offered an attempt at a sleeve resection or be treated with other modalities such as stereotactic body radiation therapy, radiofrequency, or microwave ablation.
- (3)Other more common contraindications that apply to all patients with lung cancer including contralateral or metastatic disease and persistent N2-category disease after neoadjuvant treatment.
Right Upper and Middle Lobectomy
Right Middle And Lower Lobectomy
Lymph Nodes, Checking of the Bronchial Stump(s), and Management of Residual Space
- Bilobectomy for non-small cell lung cancer: A search for clinical factors that may affect perioperative morbidity and long-term survival.J Thorac Cardiovasc Surg. 2010; 139: 606-611
- Bilobectomy for lung cancer: Analysis of Indications, postoperative results, and long-term outcomes.Ann Thorac Surg. 2012; 93: 251-258
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