Does the division of the inferior pulmonary ligament in upper lobectomy result in improved short-term clinical outcomes and long-term survival?

Abstract

Summary A best evidence topic(BET) in thoracic surgery was written according to a structured protocol. The question addressed was ‘Does the division of the inferior pulmonary ligament in upper lobectomy result in improved short-term clinical outcomes and long-term survival?’. Altogether 43 papers were found using the reported search, of which six studies represented the best evidence to answer the clinical question, including a previous BET study, a meta-analysis, and four retrospective cohort studies. The author, journal, date and country of publication, patient group studied, study type, and relevant outcomes and results of these papers are tabulated. Most of the enrolled studies reported that there is no significant difference between the division groups and the preservation groups in terms of drainage time, drainage volume, postoperative dead space and complications. While three cohort studies revealed unfavored postoperative pulmonary function in the division groups, including lung volume, forced vital capacity, and forced expiratory volume in 1 second. The previous meta-analysis and a recent cohort study also found that the division of inferior pulmonary ligament (IPL) might lead to increased bronchus angle change or torsion. Moreover, two cohort studies found that the division of IPL could not improve long-term survival of patients undergoing upper lobectomy. Current evidences showed that dividing the IPL could not result in clinical benefits but might lead to decreased pulmonary function instead. Therefore, we recommended not dissecting the IPL routinely during upper lobectomy.