Inferior Pulmonary Ligament Division May Be Unnecessary during Left Upper Lobectomy: Effects on Lung Volume, Bronchial Angle and Bronchial Tortuosity.

Duk Hwan Moon,Joon Ho Jung,Seok Jin Haam,Sungsoo Lee,Chul Hwan Park,Tae Hoon Kim

doi:10.3390/jcm10184033

Duk Hwan Moon, Joon Ho Jung + Show 4 more

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https://doi.org/10.3390/jcm10184033

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Abstract

The benefits of dissecting inferior pulmonary ligament (IPL) during upper lobectomy using video-assisted thoracoscopic surgery (VATS) for early-stage lung cancer remains controversial. This study evaluates the effect of IPL dissection by comparing the lung volume, bronchial angle, and bronchial tortuosity of the left lower lobe (LLL) during VATS upper lobectomy. Medical records of all patients who underwent VATS left upper lobectomy for early-stage lung cancer were evaluated. Patients were divided into group P (preservation) and group D (dissection). Pre- and post-surgery lung volumes, bronchial angles (angle 1: axial angulation; angle 2: vertical angulation), and bronchial tortuosity (curvature index of the left main bronchus) were measured using computed tomography images for comparison. Forty patients were included in each group. Patient characteristics such as age, gender, body mass index, and smoking status, and preoperative lung volume, bronchial angles, and tortuosity were not significantly different between the two groups, and there was no statistically significant difference in the axial and vertical angulations; however, the change in pre- and postoperative bronchial tortuosity (0.03 ± 0.03 vs. 0.06 ± 0.03) and lung volume (−558.1 ± 410.0 mL vs. −736.3 ± 382.7 mL) showed a significant difference (p < 0.001 and p = 0.04, respectively). Preservation of IPLs during left upper lobectomy may be beneficial for LLL expansion and induces less movement and positional change in the left main bronchus.

Highlights

Several thoracic surgeons believe that performing inferior pulmonary ligament (IPL)dissection during upper lobectomy leads to positive postoperative outcomes with respect to lung expansion, reduction in dead space and its accompanying pleural effusion, reduced chest tube indwelling time, and prevention of atelectasis [1,2,3,4,5]
80 patients were included; they were divided into two groups: 40 patients in the IPL preservation group and the remaining 40 patients in the IPL dissection group
The degree of left lung volume loss was less in group P than in group D, i.e., the expansion of the remaining lung was greater in the IPL preservation group

Summary

Introduction

Dissection during upper lobectomy leads to positive postoperative outcomes with respect to lung expansion, reduction in dead space and its accompanying pleural effusion, reduced chest tube indwelling time, and prevention of atelectasis [1,2,3,4,5]. Some surgeons believe that IPL preservation may be beneficial in terms of postoperative pleural fluid drainage by providing normal lymphatic drainage and channel [6,7,8,9]. They assert that IPL preservation may offer greater physiological benefits owing to the minimal change in the bronchial angle [3,4]. To the best of our knowledge, there is no convincing evidence to date suggesting whether dissection or preservation of IPL during upper lobectomy improves the postoperative outcomes and

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