title: Is the rate of pneumonectomy higher in right middle lobe lung cancer than in other right-sided locations?
abstract: BACKGROUND
  Historically, right middle lobe (RML) non-small cell lung cancer (NSCLC) has been reported to be associated with a higher rate of pneumonectomy than other right-sided locations. Because this would discourage minimally invasive approaches in RML-NSCLC, we sought to update this assertion through the study of a large surgical series.
  
  
  METHODS
  Clinical records of patients who underwent operations for right-sided NSCLC in 2 French surgical centers were prospectively entered and retrospectively reviewed. Demographic and pathologic characteristics of RML NSCLC were compared with other right-sided NSCLC.
  
  
  RESULTS
  This study included 3,234 right-sided and 211 RML (6.5%) NSCLC patients. After exclusion of 14 patients who underwent exploratory thoracotomy, patients were a mean age of 61.5 years, most RML resections occurred in men (134 [72.8%]), and most were lobectomies (wedge, n=4; lobectomy, n=102; bilobectomy, n=22; pneumonectomy, n=56). Pathologic analysis revealed adenocarcinoma in 88 patients (47.8%) and squamous cell carcinoma in 80 (43.5%). pStaging was stage I in 86 patients (46.7%), II in 42 (22.8%), III in 47 (25.5%), and IV in 9 (4.9%). Superior and inferior mediastinal N2 were found in 45.4% and 54.6% of patients, respectively, when 1 station was involved. When compared with other right-sided NSCLC, RML was characterized by higher T status and higher rates of bilobectomy (10.9% vs 5.6%, p=0.0017) and pneumonectomy (30.3% vs 22.3%, p=0.0071) but similar 5-year survival (47.4%).
  
  
  CONCLUSIONS
  Compared with other right-sided NSCLC, RML location is associated with a higher albeit limited rate of pneumonectomy.
authors.affiliation: General Thoracic Surgery, Georges Pompidou European Hospital, Paris-Descartes-University, Paris, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Rivera
authors.affiliation: General Thoracic Surgery, Georges Pompidou European Hospital, Paris-Descartes-University, Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Mordant
authors.affiliation: General Thoracic Surgery, Georges Pompidou European Hospital, Paris-Descartes-University, Paris, France.
authors.forename: Ciprian
authors.initials: C
authors.lastname: Pricopi
authors.affiliation: General Thoracic Surgery, Georges Pompidou European Hospital, Paris-Descartes-University, Paris, France.
authors.forename: Alex
authors.initials: A
authors.lastname: Arame
authors.affiliation: General Thoracic Surgery, Georges Pompidou European Hospital, Paris-Descartes-University, Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Foucault
authors.affiliation: General Thoracic Surgery, Cedar Surgical Centre, Bois-Guillaume, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Dujon
authors.affiliation: General Thoracic Surgery, Georges Pompidou European Hospital, Paris-Descartes-University, Paris, France.
authors.forename: Françoise
authors.initials: F
authors.lastname: Le Pimpec Barthes
authors.affiliation: General Thoracic Surgery, Georges Pompidou European Hospital, Paris-Descartes-University, Paris, France. Electronic address: marc.riquet@egp.aphp.fr.
authors.forename: Marc
authors.initials: M
authors.lastname: Riquet
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D015996:Survival Rate
keywords: 10