Surgical endoscopy · 2026
Inferior pulmonary ligament preservation improves early residual lung compensatory function particularly after right upper lobectomy: a prospective randomized controlled trial.
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Hu Juyi, Chen Maodan, Huang Yang, Zhu Wenfei, Li Zewei, Rao Bingyu, Wu Yuanzhou, Zhang Fuwei, Chen Qunqing, Li Hui
Аннотация
BACKGROUND: Compensatory lung expansion following lobectomy is essential for functional recovery. Division of the inferior pulmonary ligament (IPL) during thoracoscopic upper lobectomy is commonly performed to facilitate residual lung expansion, yet its efficacy remains unproven, and the procedure may compromise bronchial anatomy. We conducted a prospective randomized controlled trial to evaluate the impact of IPL preservation versus division on postoperative pulmonary compensation using quantitative three-dimensional (3D) functional lung volume (FLV) analysis.
METHODS: Patients undergoing thoracoscopic upper lobectomy for non-small cell lung cancer were intraoperatively randomized to IPL preservation (group P, n=33) or division (group D, n=33). Primary outcomes included FLV and forced expiratory volume in one second (FEV₁) at 1, 3, and 6 months postoperatively. Secondary outcomes comprised residual bronchial angles, residual thoracic cavity rate, total lung volume, perioperative parameters, and comparison of residual lung volume.
RESULTS: After right upper lobectomy, group P had significantly less 1-month FLV loss (- 420±312 mL vs. -488±283 mL, P=0.027) and FEV₁ loss (- 0.46±0.28 L vs. -0.79±0.33 L, P=0.035), plus faster recovery between 1 and 3 months (all P<0.05). Residual bronchial angle changes were significantly smaller in group P at 1 month (14.5±9.2° vs. 19.3±10.5°, P=0.036) and 3 months (18.4±8.2° vs. 23.2±9.8°, P=0.047). Postoperative hospital stay was shorter in group P (4.7±1.6 days vs. 5.8±1.4 days, P=0.046). No significant differences were seen in residual cavity rate, total lung volume, or any outcome after left upper lobectomy.
CONCLUSIONS: Preservation of the IPL during thoracoscopic upper lobectomy mitigates early pulmonary function decline, accelerates compensatory recovery, and maintains bronchial stability following right upper lobectomy, without increasing complications. These findings support selective IPL preservation to improve early postoperative recovery, particularly in right-sided resections.
METHODS: Patients undergoing thoracoscopic upper lobectomy for non-small cell lung cancer were intraoperatively randomized to IPL preservation (group P, n=33) or division (group D, n=33). Primary outcomes included FLV and forced expiratory volume in one second (FEV₁) at 1, 3, and 6 months postoperatively. Secondary outcomes comprised residual bronchial angles, residual thoracic cavity rate, total lung volume, perioperative parameters, and comparison of residual lung volume.
RESULTS: After right upper lobectomy, group P had significantly less 1-month FLV loss (- 420±312 mL vs. -488±283 mL, P=0.027) and FEV₁ loss (- 0.46±0.28 L vs. -0.79±0.33 L, P=0.035), plus faster recovery between 1 and 3 months (all P<0.05). Residual bronchial angle changes were significantly smaller in group P at 1 month (14.5±9.2° vs. 19.3±10.5°, P=0.036) and 3 months (18.4±8.2° vs. 23.2±9.8°, P=0.047). Postoperative hospital stay was shorter in group P (4.7±1.6 days vs. 5.8±1.4 days, P=0.046). No significant differences were seen in residual cavity rate, total lung volume, or any outcome after left upper lobectomy.
CONCLUSIONS: Preservation of the IPL during thoracoscopic upper lobectomy mitigates early pulmonary function decline, accelerates compensatory recovery, and maintains bronchial stability following right upper lobectomy, without increasing complications. These findings support selective IPL preservation to improve early postoperative recovery, particularly in right-sided resections.