The right middle lobe is unique because it is surrounded by two other lobes and the pericardium, and it is the smallest lobe. The proper surgical treatment and prognosis for cancer of the right middle lobe has not been definitively established. In order to clarify its prognosis and the best operative technique, 31 surgically treated patients with lung cancer of the right middle lobe were studied clinically and pathologically. The outcome of surgical treatment of the right middle lobe cancer was compared with other locations in the lung. The 5-year survival rate of this group was 51.5%, with a median survival time of 82.3 months. For resectable cases, the outcome for carcinomas of the middle lobe was no worse than for other locations. However the rate of exploratory thoracotomy was highest for the right middle lobe. All five patients with lobectomies are alive and disease free at 26.4-151.4 months. The 5-year survival rate of 23 bilobectomies was 40.0%, with a median survival time of 48.4 months. The difference between lobectomy and bilobectomy cases was statistically significant (P < 0.025). When the tumor was limited to the completely separated middle lobe without dissemination, pulmonary or mediastinal lymph node metastasis, lobectomy was sufficient for curative treatment.
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