Effect of inferior pulmonary ligament division on residual lung volume and function after a right upper lobectomy

The requirement to divide an inferior pulmonary ligament (IPL) during an upper lobectomy has not been standardized. We evaluated the influence of the division of an IPL after a lobectomy of the right upper lobe.

We evaluated 52 patients with lung cancer who underwent a video-assisted thoracoscopic lobectomy of the right upper lobe at Asan Medical Center between January 2011 and April 2014. These cases were stratified by division of the IPL or not, i.e. a preservation group (group P, n = 21) and a division group (group D, n = 31). The angle between the bronchus intermedius and the right middle lobe bronchus and the lung volume were measured using computed tomography. The results of the pulmonary function tests and the prevalence of complications were also reviewed.

The prevalences of atelectasis (P = 0.538), dead space (P = 0.084) and pleural effusion (P = 0.538) were not statistically different. The postoperative volumetric change of the right middle lobe (group P, -27 ± 97 ml; group D, -29 ± 111 ml; P = 0.950) and of the right lower lobe (group P, 397 ± 293 ml; group D, 335 ± 294 ml; P = 0.459) did not show statistical differences. The change in the bronchial angle was not statistically different between the groups (group P, -26.3 ± 13.7°; group D, -26.7 ± 13.6°; P = 0.930). The patients in group D experienced a greater loss in forced vital capacity than those in group P (group P, -0.16 ± 0.26 l; group D, -0.42 ± 0.33 l; P = 0.007), but the loss in the forced expiratory volume in 1 s was not significant (P = 0.328).

An IPL division does not produce significant differences in lung volume, bronchial angle change or prevalence of complications other than loss of forced vital capacity.