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Inferior pulmonary ligament division during left upper lobectomy causes pulmonary dysfunction.

Shoji Kuriyama1, Kazuhiro Imai1, Hajime Saito2

  • 1Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan.

Interdisciplinary Cardiovascular and Thoracic Surgery
|February 17, 2023
PubMed
Summary

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Dividing the inferior pulmonary ligament during left upper lobectomy may cause lung dysfunction and airflow limitation. Preserving the ligament appears to improve postoperative pulmonary function, especially after left-sided procedures.

Area of Science:

  • Thoracic Surgery
  • Pulmonary Function Analysis
  • Surgical Anatomy

Background:

  • The division of the inferior pulmonary ligament (IPL) during upper lobectomy (UL) was traditionally considered essential for lung expansion.
  • However, its impact on postoperative pulmonary function remains debated, necessitating further investigation.

Purpose of the Study:

  • To evaluate the effect of IPL division on postoperative pulmonary function and complications following upper lobectomy.

Main Methods:

  • A retrospective analysis of 213 patients undergoing UL, divided into IPL division (D group) and preservation (P group) cohorts.
  • Assessment included chest X-rays, spirometry for pulmonary function (FVC, FEV1), and 3D CT scans to analyze bronchial changes.

Main Results:

Keywords:
Bronchial kinkInferior pulmonary ligamentLung cancerPulmonary functionUpper lobectomy

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  • No significant differences in complications or pulmonary function were observed after right UL between the groups.
  • Left UL showed significantly better pulmonary function (FVC, FEV1) in the IPL preservation group compared to the division group.
  • Left UL in the division group exhibited a smaller cross-sectional area and circumference of the narrowed bronchus, suggesting bronchial kinking.

Conclusions:

  • Division of the IPL during left UL can lead to postoperative pulmonary dysfunction and airflow limitation, potentially due to bronchial kinking.
  • Preservation of the IPL may be beneficial for maintaining optimal postoperative pulmonary function after left upper lobectomy.