Application of loosening the inferior pulmonary ligament in thoracoscopic right upper lobe apical segment resection for non-small cell lung cancer: A prospective study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 HAN Leyang ¹ , ZHAO Long ² , CHEN Dong ¹ , HE Yiqi ¹

1. Cardiothoracic Surgery Department, Zhejiang Xiaoshan Hospital, Hangzhou, 311200, P. R. China;
2. Cardiothoracic Surgery Department, Ningbo Second Hospital, Ningbo, 315153, Zhejiang, P. R. China;

Corresponding?author：

HAN Leyang, Email: 540409260@qq.com

Keywords：

Non-small cell lung cancer; thoracoscopy; right upper lobe apical segment resection; inferior pulmonary ligament

DOI：

10.7507/1007-4848.202305043

Video：

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Objective To compare the effects of preserving and releasing the inferior pulmonary ligament (IPL) during thoracoscopic right upper lobe apical segment resection for non-small cell lung cancer patients, and to explore appropriate management methods for intraoperative IPL. Methods According to the prospective and open principle, the patients with non-small cell lung cancer who underwent thoracoscopic right upper lobe apical segment resection in the Cardiothoracic Surgery Department of Ningbo Second Hospital from January 2020 to November 2022 were selected and divided into two groups: a release group (receiving IPL release during thoracoscopic right upper lobe apical segment resection) and a retention group (receiving the same right upper lobe apical segment resection, but retaining IPL during operation). The clinical data of the two groups were compared. Results A total of 70 patients were included in this study, including 33 males and 37 females, aged 35-76 years. There were 35 patients in the release group with an average age of (57.02±9.25) years; 35 patients in the retention group with an average age of (56.81±9.94) years. The surgical time in the release group was statistically longer than that in the retention group (P=0.017). There was no statistical difference between the two groups in terms of intraoperative bleeding, duration of postoperative air leakage, time to achieve lung recruitment, drainage flow rate of the chest tube, retention time of the chest tube, incidence of postoperative complications, postoperative hospitalization days, or residual cavity rate one month after the surgery (P>0.05). Conclusion Compared to releasing IPL during thoracoscopic right upper lobe apical segment resection, preserving IPL can simplify surgical procedures, shorten surgical time and reduce trauma, and does not increase postoperative adverse effects. This further reflects the concept of minimally invasive surgery and can be applied to clinical practice.

Citation： HAN Leyang, ZHAO Long, CHEN Dong, HE Yiqi. Application of loosening the inferior pulmonary ligament in thoracoscopic right upper lobe apical segment resection for non-small cell lung cancer: A prospective study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2025, 32(8): 1121-1126. doi: 10.7507/1007-4848.202305043 Copy

1.	Chen W, Sun K, Zheng R, et al. Cancer incidence and mortality in China, 2014. Chin J Cancer Res, 2018, 30(1): 1-12.
2.	郭海法, 毛鋒, 張輝, 等. 同時性多原發肺癌的預后及生存相關因素研究. 中國肺癌雜志, 2017, 20(1): 21-27.Guo HF, Mao F, Zhang H, et al. Analysis on the prognostic and survival factors of synchronous multiple primary lung cancer. Chin J Cancer, 2017, 20(1): 21-27.
3.	Watanabe S, Asamura H, Suzuki K, et al. The new strategy of selective nodal dissection for lung cancer based on segment-specific patterns of nodal spread. Interact Cardiovasc Thorac Surg, 2005, 4(2): 106-109.
4.	王成弟, 陳勃江, 宋璐佳, 等. 23 228例肺癌患者臨床流行病學及病理特征趨勢分析. 華西醫學, 2020, 35(7): 813-820.Wang CD, Chen BJ, Song LJ, et al. Epidemiological and pathological distribution characteristics in 23 228 lung cancer patients. West China Med J, 2020, 35(7): 813-820.
5.	Shapiro M, Weiser TS, Wisnivesky JP, et al. Thoracoscopic segmentectomy compares favorably with thoracoscopic lobectomy for patients with small stageⅠlung cancer. J Thorac Cardiovasc Surg, 2009, 137(6): 1388-1393.
6.	Gómez-Caro A, Roca MJ, Torres J, et al. Successful use of a single chest drain postlobectomy instead of two classical drains: a randomized study. Eur J Cardiothorac Surg, 2006, 29(4): 562-566.
7.	Matsuoka H, Nakamura H, Nishio W, et al. Division of the pulmonary ligament after upper lobectomy is less effective for the obliteration of dead space than leaving it intact. Surg Today, 2004, 34(6): 498-500.
8.	李家言. 肺韌帶影像學. 中國醫學影像技術, 2005, 2: 318-320.Li JY. Medical imaging of pulmonary ligament. Chin J Med Imaging Technol, 2005, 2: 318-320.
9.	Riquet M, Le Pimpec Barthes F, Souilamas R, et al. Thoracic duct tributaries from intrathoracic organs. Ann Thorac Surg, 2002, 73(3): 892-898.
10.	陳亮, 王俊, 吳衛兵, 等. 胸腔鏡精準肺段切除術技術流程和質量控制. 中國胸心血管外科臨床雜志, 2019, 26(1): 21-28.Chen L, Wang J, Wu WB, et al. Technical process and quality control of precise thoracoscopic lung segmentectomy. Chin J Clin Thorac Cardiovasc Surg, 2019, 26(1): 21-28.
11.	Usuda K, Sagawa M, Aikawa H, et al. Do Japanese thoracic surgeons think that dissection of the pulmonary ligament is necessary after an upper lobectomy? Surg Today, 2010, 40(11): 1097-1099.
12.	Kim CW, Godelman A, Jain VR, et al. Postlobectomy chest radiographic changes: a quantitative analysis. Can Assoc Radiol J, 2011, 62(4): 280-287.
13.	Ueda K, Tanaka T, Hayashi M, et al. Clinical ramifications of bronchial kink after upper lobectomy. Ann Thorac Surg, 2012, 93(1): 259-265.
14.	Van Leuven M, Clayman JA, Snow N. Bronchial obstruction after upper lobectomy: kinked bronchus relieved by stenting. Ann Thorac Surg, 1999, 68(1): 235-237.
15.	Masuda Y, Marutsuka T, Suzuki M. A risk factor for kinked middle lobar bronchus following right upper lobectomy. Asian Cardiovasc Thorac Ann, 2014, 22(8): 955-959.
16.	Shipley RT, Mahoney MC. Right middle lobe collapse following right upper lobectomy. Radiology, 1988, 166(3): 725-728.
17.	Khanbhai M, Dunning J, Yap KH, et al. Dissection of the pulmonary ligament during upper lobectomy: is it necessary? Interact Cardiovasc Thorac Surg, 2013, 17(2): 403-406.
18.	Terzi A, Furlan G, Magnanelli G, et al. Chylothorax after pleuro-pulmonary surgery: a rare but unavoidable complication. Thorac Cardiovasc Surg, 1994, 42(2): 81-84.

1. Chen W, Sun K, Zheng R, et al. Cancer incidence and mortality in China, 2014. Chin J Cancer Res, 2018, 30(1): 1-12.
2. 郭海法, 毛鋒, 張輝, 等. 同時性多原發肺癌的預后及生存相關因素研究. 中國肺癌雜志, 2017, 20(1): 21-27.Guo HF, Mao F, Zhang H, et al. Analysis on the prognostic and survival factors of synchronous multiple primary lung cancer. Chin J Cancer, 2017, 20(1): 21-27.
3. Watanabe S, Asamura H, Suzuki K, et al. The new strategy of selective nodal dissection for lung cancer based on segment-specific patterns of nodal spread. Interact Cardiovasc Thorac Surg, 2005, 4(2): 106-109.
4. 王成弟, 陳勃江, 宋璐佳, 等. 23 228例肺癌患者臨床流行病學及病理特征趨勢分析. 華西醫學, 2020, 35(7): 813-820.Wang CD, Chen BJ, Song LJ, et al. Epidemiological and pathological distribution characteristics in 23 228 lung cancer patients. West China Med J, 2020, 35(7): 813-820.
5. Shapiro M, Weiser TS, Wisnivesky JP, et al. Thoracoscopic segmentectomy compares favorably with thoracoscopic lobectomy for patients with small stageⅠlung cancer. J Thorac Cardiovasc Surg, 2009, 137(6): 1388-1393.
6. Gómez-Caro A, Roca MJ, Torres J, et al. Successful use of a single chest drain postlobectomy instead of two classical drains: a randomized study. Eur J Cardiothorac Surg, 2006, 29(4): 562-566.
7. Matsuoka H, Nakamura H, Nishio W, et al. Division of the pulmonary ligament after upper lobectomy is less effective for the obliteration of dead space than leaving it intact. Surg Today, 2004, 34(6): 498-500.
8. 李家言. 肺韌帶影像學. 中國醫學影像技術, 2005, 2: 318-320.Li JY. Medical imaging of pulmonary ligament. Chin J Med Imaging Technol, 2005, 2: 318-320.
9. Riquet M, Le Pimpec Barthes F, Souilamas R, et al. Thoracic duct tributaries from intrathoracic organs. Ann Thorac Surg, 2002, 73(3): 892-898.
10. 陳亮, 王俊, 吳衛兵, 等. 胸腔鏡精準肺段切除術技術流程和質量控制. 中國胸心血管外科臨床雜志, 2019, 26(1): 21-28.Chen L, Wang J, Wu WB, et al. Technical process and quality control of precise thoracoscopic lung segmentectomy. Chin J Clin Thorac Cardiovasc Surg, 2019, 26(1): 21-28.
11. Usuda K, Sagawa M, Aikawa H, et al. Do Japanese thoracic surgeons think that dissection of the pulmonary ligament is necessary after an upper lobectomy? Surg Today, 2010, 40(11): 1097-1099.
12. Kim CW, Godelman A, Jain VR, et al. Postlobectomy chest radiographic changes: a quantitative analysis. Can Assoc Radiol J, 2011, 62(4): 280-287.
13. Ueda K, Tanaka T, Hayashi M, et al. Clinical ramifications of bronchial kink after upper lobectomy. Ann Thorac Surg, 2012, 93(1): 259-265.
14. Van Leuven M, Clayman JA, Snow N. Bronchial obstruction after upper lobectomy: kinked bronchus relieved by stenting. Ann Thorac Surg, 1999, 68(1): 235-237.
15. Masuda Y, Marutsuka T, Suzuki M. A risk factor for kinked middle lobar bronchus following right upper lobectomy. Asian Cardiovasc Thorac Ann, 2014, 22(8): 955-959.
16. Shipley RT, Mahoney MC. Right middle lobe collapse following right upper lobectomy. Radiology, 1988, 166(3): 725-728.
17. Khanbhai M, Dunning J, Yap KH, et al. Dissection of the pulmonary ligament during upper lobectomy: is it necessary? Interact Cardiovasc Thorac Surg, 2013, 17(2): 403-406.
18. Terzi A, Furlan G, Magnanelli G, et al. Chylothorax after pleuro-pulmonary surgery: a rare but unavoidable complication. Thorac Cardiovasc Surg, 1994, 42(2): 81-84.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Application of loosening the inferior pulmonary ligament in thoracoscopic right upper lobe apical segment resection for non-small cell lung cancer: A prospective study

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