Division of the Pulmonary Ligament After Upper Lobectomy is Less Effective for the Obliteration of Dead Space than Leaving It Intact

Matsuoka, Hidehito; Nakamura, Hiroshi; Nishio, Wataru; Sakurai, Toshihiko; Harada, Hiroaki; Tsubota, Noriaki

doi:10.1007/s00595-004-2752-2

Cited by 21 publications

(13 citation statements)

References 3 publications

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“…The results of this questionnaire also suggest that the preservation of the pulmonary ligament increases the instances of pooling of pleural effusion while decreasing the instances of bronchial stenosis or obstruction. Matsuoka et al 3 recommend the preservation of the pulmonary ligament because the division of the pulmonary ligament after an upper lobectomy is less effective for the reduction of the free thoracic space than leaving it intact. The preservation of the pulmonary ligament is effective in preventing the deformation of the residual bronchus.…”

Section: Discussionmentioning

confidence: 99%

Do Japanese thoracic surgeons think that dissection of the pulmonary ligament is necessary after an upper lobectomy?

et al. 2010

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It is uncertain whether the dissection of the pulmonary ligament is necessary in patients who undergo an upper lobectomy. A questionnaire was sent to the directors of Thoracic Surgery in 102 hospitals, asking whether dissection of the pulmonary ligament is performed in such patients, and the complications associated with dissecting or preserving the ligament. Seventy-eight directors (76%) returned the questionnaire. The preservation of the ligament is the current practice in 54 hospitals (69%), while 13 hospitals (17%) occasionally dissect, 9 hospitals (11%) regularly dissect, and 2 hospitals (3%) half dissect the ligament. Thirty directors experienced complications which were thought to be associated with dissecting the ligament: bronchial stenosis (21 directors), atelectasis (8), and bronchial obstruction (4). Twenty-six directors described complications thought to be associated with preserving the ligament: the pooling of pleural effusion (19 directors), insufficient expansion of lung (18), atelectasis (8), and empyema (7). Preservation of the ligament may therefore be useful in preventing bronchial stenosis and obstruction, while its dissection may be useful to prevent the pooling of pleural effusion.

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Section: Discussionmentioning

confidence: 99%

Do Japanese thoracic surgeons think that dissection of the pulmonary ligament is necessary after an upper lobectomy?

et al. 2010

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“…ChinaCCT10050503763*****Kim DH [11]. KoreaCCT523121None52*******Matsuoka, H [12]. JapanRCT3517181223_Qi HF [13].…”

Section: Resultsmentioning

confidence: 99%

“…In other three studies, a method described by Matsuoka et al [12] was used to evaluate the residual dead space in the left or right apex of thorax. The random effects model was used because of the high heterogeneity among the studies ( I 2 = 58%, P = 0.09; I 2 = 51%, P = 0.13).…”

Section: Resultsmentioning

confidence: 99%

The choice of dissection or preservation of the inferior pulmonary ligament after an upper lobectomy: a systematic review and meta-analysis

Zhou

Zhan

et al. 2020

World J Surg Onc

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Background: The necessity of the inferior pulmonary ligament (IPL) dissection after an upper lobectomy remains controversial. This meta-analysis aimed to evaluate whether this accessional procedure could reduce the postoperative complications and improve outcomes. Methods: PubMed, Embase, Ovid, Cochrane Library, CBM, and CNKI databases were searched for the relevant studies which compared the dissection with preservation of IPL during the upper lobectomy. The Review Manager 5.3 software was used for this meta-analysis. Results: Three RCTs and five CCTs were included in this meta-analysis. These studies contained a total of 610 patients, in which 315 patients received a pulmonary ligament dissection (group D) after the upper lobectomy, while the other 295 patients preserved the pulmonary ligament (group P). No significant difference was demonstrated between the group D and group P in terms of drainage time after surgery (MD 0.14, 95%CI − 0.05 to 0.33, P = 0.15), rate of postoperative dead space (OR 1.33, 95%CI 0.72 to 2.46, P = 0.36), rate of postoperative complications (OR 1.20, 95%CI 0.66 to 2.19, P = 0.56). However, the pooled comparison revealed a greater change of the right main bronchial angle (MD 5.00, 95%CI 1.68 to 8.33, P = 0.003) in group D compared with group P, indicated that the dissection of IPL may lead to a greater distortion of bronchus. Conclusions: This meta-analysis confirmed that the dissection of IPL do not effectively reduce the postoperative complications and improve the prognosis. Therefore, it is not necessary to dissect the IPL after an upper lobectomy.

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“…However, there is no convincing evidence that the preservation of the pulmonary ligament in an upper lobectomy reduces these complications. Matsuoka et al 11) conducted a randomized controlled trial of 35 consecutive patients undergoing upper lobectomy for lung cancer. They sometimes had experienced the deformation of the residual bronchus after left upper lobectomy with ligament division.…”

Section: Editorialmentioning

confidence: 99%

Bronchial Deformation Associated with Lobectomy

Kadokura

2015

ATCS

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EditorialBronchial stenosis or obstruction (BSO) can arise as a congenital disorder with other associated abnormalities, but it may also occur as an acquired lesion secondary to other conditions. 1-4) BSO after chest surgery is a relatively rare condition. BSO after upper lobectomy probably occurs due to upward movement of the remaining lobe(s) with torsion or deformation of the bronchus. The diagnosis of BSO can be confirmed at the time of bronchofiberscopy (BF) or computed tomography (CT) scan by the findings of a kinked lobar bronchus. Bronchofiberscopic findings will show partial or complete obstruction of the bronchus to the affected lobe, which is caused by edema or distortion. In addition, there are some radiological findings of lung lobar torsion: (1) a collapsed or consolidated lobe that occupies an unusual position on chest roentgenography or CT scan; (2) hilar displacement in a direction inappropriate for the lobe that appears to be atelectasis; (3) alteration in the normal position and sweep of the pulmonary vasculature-if central vascular markings extend laterally from the hilus and then sweep superiorly instead of inferiorly, lobar torsion can be postulated; (4) rapid opacification of an ipsilateral lobe following chest surgery-the thorax may be completely opaque, especially if an entire lung has undergone torsion; (5) a change in position of an opacified lobe on sequentially obtained chest roentgenography; (6) bronchial distortion, demonstrated occasionally on chest roentgenography, but better seen on CT scans; (7) lobar air trapping; and (8) signs of lobar collapse. 5) Among the various reasons for bronchial deformation, lung torsion is fatal. Brooks 6) described that lung lobar torsion of the right middle lobe after upper lobectomy is the most common, but it can occur in all lobes. Arai et al. 7) reported bronchial deformation of the left lower lobe bronchus after left upper lobectomy. Wong et al. 8) reported 28 cases of lobar torsion after lung resection; 16 (57%) of these 28 cases involved middle lobe torsion after right upper lobectomy. The others involved left upper lobe torsion after left lower lobectomy, and right lower lobe torsion after right upper lobectomy. There are published articles on left lower lobe torsion after left upper lobectomy, as well as right lower lobe torsion after right upper lobectomy. 9) Brooks 6) asserted that the fissure must be completely isolated between the remaining lobes. Furthermore, torsion of the lower lobe cannot occur if the inferior pulmonary ligament is not divided. He recommended that care be taken to prevent torsion of the remaining lobes, which may become fixed together by suturing, and complete re-expansion of the lung during chest closure is essential to prevent lung lobar torsion. Wong et al. 8) recommended that, after lobectomy, the remaining lobe(s) be anchored with sutures to minimize the likelihood of pulmonary torsion. Khanbhai et al. 10) reported that the division of the pulmonary ligament reduces the free space in the upper thorax and may...

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Division of the Pulmonary Ligament After Upper Lobectomy is Less Effective for the Obliteration of Dead Space than Leaving It Intact

Abstract: Division of the pulmonary ligament after upper lobectomy is less effective for the obliteration of dead space than leaving it intact.

Cited by 21 publications

References 3 publications

Do Japanese thoracic surgeons think that dissection of the pulmonary ligament is necessary after an upper lobectomy?

Do Japanese thoracic surgeons think that dissection of the pulmonary ligament is necessary after an upper lobectomy?

The choice of dissection or preservation of the inferior pulmonary ligament after an upper lobectomy: a systematic review and meta-analysis

Bronchial Deformation Associated with Lobectomy

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