Our experience of ipsilateral lobar lymph node dissection in lung cancer

Aim. Development of the technique for performing ipsilateral lobar lymph node dissection.

Methods. Ipsilateral lobar lymph node dissection was performed in 40 patients diagnosed with non-small cell lung cancer when performing radical surgical treatment (lung resection with systematic lymph node dissection). First of all, ipsilateral lobar lymph node dissection was performed on the lung sample after pneumonectomy. After having developed the technique, dissection was performed during lobectomy through thoracotomy access. After having mastered the technique of performing dissection through thoracotomy access, ipsilateral lobar lymph node dissection was performed during lobectomy through thoracoscopic access (initially double-port, then uniportal one). The lobar lymph nodes are located along lobar bronchi and are directly adjacent to them (in proximity to the vessels of the lung), most of them are surrounded by pulmonary tissue without surrounding fat and are covered with a thin fascial layer. The absence of surrounding fatty tissue and close proximity of vascular structures technically complicate lymph node dissection of this group. Due to the described features, ipsilateral lobar lymph node dissection was considered in two main aspects: from the point of view of access to this group of lymph nodes and the technique of their dissection.

Results. The technique of performing ipsilateral lobar lymph node dissection is similar to the stages of mobilization of bronchial structures in lobectomy and segmentectomy, however, it has a number of peculiarities associated first of all with the novelty of the proposed technique presented in this aspect for the first time. It is feasible for any lobar location, but is laborious in left-sided upper lobectomy. This technique is adapted for videothoracoscopy and can be successfully performed in both uniportal and double-port videothoracoscopic lobectomy.

Conclusion. The technique of performing ipsilateral lobar lymph node dissection was developed, which is reproducible in case of thoracotomy and videotoracoscopic access.