Advantage of Sleeve Right Lower Lobectomy for Lung Cancer in COPD Patients: A Case Series

Sleeve right lower lobectomy (SRLL) is an uncommon procedure for right lower lobe lung cancer involving the intermediate bronchus, mainly because it is more technically demanding than lower bilobectomy (LBL), particularly due to challenges such as bronchial caliber mismatch and anastomotic tension. We retrospectively reviewed four chronic obstructive pulmonary disease (COPD) patients who underwent SRLL at Akita University Hospital (2020-2023). All cases had squamous cell carcinoma pStage IB-IIB. Postoperative respiratory function exceeded the predicted postoperative values for LBL and even for right lower lobectomy, suggesting preservation of pulmonary function beyond initial estimates. One bronchopleural fistula occurred, but it healed with conservative treatment. No recurrences were observed. SRLL with middle lobe preservation may improve outcomes by reducing complications and preserving pulmonary function, especially in COPD patients.