Effect of Right Middle-to-Lower Lobe Fixation on Postoperative Lung Volume after Right Upper Lobectomy

Cranial migration of the right middle lobe (RML) after right upper lobectomy may cause bronchial angulation and alter postoperative lung volume distribution. We investigated whether RML fixation techniques affect postoperative lobar volume and pulmonary function.

This retrospective single-center study included 96 patients who underwent right upper lobectomy for non-small cell lung cancer (2009-2020). Patients were classified into 3 groups: no fixation, normal fixation, and sliding (anterior-caudal) fixation of the RML to the right lower lobe (RLL). Lobar volumes were assessed using 3-dimensional computed tomography volumetry, and postoperative pulmonary function tests were analyzed when available.

Both lower lobes showed significant compensatory expansion, with the RLL demonstrating the largest increase. Overall, RML volume did not change significantly. However, RML volume increased in the normal fixation group (+58.9 ± 78.2 mL) but decreased in the sliding-fixation (-29.0 ± 92.6 mL) and no-fixation groups (-16.9 ± 118.9 mL), with significant differences among groups (p <0.001). Postoperative changes in forced vital capacity and forced expiratory volume in 1 second did not differ among groups, and RML volume change was not correlated with pulmonary function.

Normal RML fixation preserved RML volume after right upper lobectomy, but did not improve postoperative pulmonary function. Further studies are warranted.