Comparison of preservation, dissection of 50% and 100% inferior pulmonary ligament during video-assisted thoracoscopic surgery in upper lobectomy of lung cancer

Abstract

Background Preservation or dissection of the inferior pulmonary ligament (IPL) during performing upper lobectomy by video-assisted thoracoscopic (VATS) remains controversial. Also, whether dissecting 50%IPL can combine the advantages of both preservation and dissection or not remains controversial as well. This retrospective study analyzed the short-term clinical effects of preservation, dissection of 50%IPL, and dissection of 100%IPL during VATS for upper lobectomy. Methods A total of 104 patients with lung cancer who underwent VATS of upper lobectomy from May 2019 to December 2020 were selected and divided into three groups, 34 cases of preserving IPL as control group A, 35 cases of dissecting 50% IPL as group B, and 35 cases of dissecting 100% IPL as group C. This study mainly analyzed surgery time, intraoperative blood loss and intraoperative infusion volume, postoperative outcomes such as drainage time, hospital stay, and complications such as atelectasis, pneumothorax, pleural effusion, and white blood cell count (WBC), and neutrophils (NEU) in these cases. Results No significant differences were identified in surgery time(P = 0.526). Intraoperative blood loss was significantly lower in groups B and C than in group A (P = 0.000). Intraoperative infusion volume in group B was significantly lower than that in group C and group A (P = 0.009). The postoperative drainage time of group B was similar to that in group C, and was significantly lower than that of group A (P = 0.001). Group B had the shortest duration of postoperative hospital stay, and group C was slightly lower than group A (P = 0.001). No significant differences were demonstrated in atelectasis, pneumothorax, pleural effusion, postoperative WBC and postoperative NEU (P = 0.133,0.596,0.361,0.305, and 0.278 respectively). However, the prevalence of total complications in group B was the lowest, and in Group C was slightly lower than that in group A (P = 0.038). The results were similar in the left and right upper lungs. Conclusions The drainage time, hospital stay, and postoperative complications of dissecting 50%IPL were less than those of dissecting 100%IPL and IPL preservation. The intraoperative blood loss and postoperative drainage time of dissecting 100%IPL were slightly lower than preservation, and the intraoperative infusion volume and complications were similar to preservation.