Preservation vs. dissection of inferior pulmonary ligament for thoracoscopic upper lobectomy: a prospective randomized controlled trial

• Published in: World journal of surgical oncology Vol. 21; no. 1; pp. 1 - 313
• Main Authors: Qian, Jiekun, Cai, Shixian, Lin, Pinghua, Chi, Wanzhong, Chen, Chun, Xu, Guobin, Xu, Chi, Wu, Weidong, Zheng, Wei, Zheng, Bin
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 07.10.2023; BioMed Central; BMC
• Subjects: Care and treatment; Catheters; Complications; Diagnosis; Dissection; Hospitals; Inferior pulmonary ligament; Ligaments; Lung cancer; Lung cancer, Non-small cell; Lungs; Lymphatic system; Measurement techniques; Medical imaging; Patient outcomes; Patients; Pleural effusion; Postoperative; Preservation; Residual bronchial angle change; Software; Surgeons; Surgery; Thoracic surgery; Thoracoscopic upper lobectomy; Thoracoscopy; China
• ISSN: 1477-7819; 1477-7819
• DOI: 10.1186/s12957-023-03190-8

Objectives The proper procedure for inferior pulmonary ligament (IPL) during upper lobectomy remains a topic of debate. To address this matter, we carried out a trial comparing the clinical outcomes of IPL preservation versus IPL dissection during thoracoscopic upper lobectomy (TUL). Methods Patients undergoing thoracoscopic left/right upper lobectomy (TLUL/TRUL) were assigned to either the dissection group (Group D) or the preservation group (Group P). Our primary objective was to quantify and compare the alterations in postoperative residual bronchial angle and lung volume changes between the two groups. Our secondary objective encompassed the assessment of various other intraoperative and postoperative outcomes. Results Following adherence to the inclusion and exclusion criteria, we enrolled 100 patients (41 left and 59 right) in Group P and 108 patients (41 left and 67 right) in Group D for the study. Our findings revealed that in TLUL, Group P was able to reduce the degree of postoperative residual bronchial angle change (P < 0.05). Conversely, the situation was distinct for TRUL. We found no notable disparity between the two groups (P > 0.05) with regard to alterations in lung volume or the occurrence of postoperative complications--except for the duration of postoperative hospital stay (P < 0.05). Conclusions Our study suggests IPL preservation especially for TLUL when compared to TRUL, which have important implications for the clinical management of patients undergoing upper lobectomy. Keywords: Thoracoscopic upper lobectomy, Inferior pulmonary ligament, Residual bronchial angle change