Application of thoracoscopic right upper lobe apical segment resection for non-small cell lung cancer by loosening the inferior pulmonary ligament_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 randomly 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 thoracic duct, retention time of the thoracic duct, 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.

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2.	郭海法, 毛锋, 张辉, 等. 同时性多原发肺癌的预后及生存相关因素研究. 中国肺癌杂志, 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.
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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. 肺韧带影像学. 中国医学影像技术, 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.	陈亮,王俊,吴卫兵,等. 胸腔镜精准肺段切除术技术流程和质量控制. 中国胸心血管外科临床杂志, 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, 毛锋, 张辉, 等. 同时性多原发肺癌的预后及生存相关因素研究. 中国肺癌杂志, 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, 陈勃江, 宋璐佳, 等. 23228例肺癌患者临床流行病学及病理特征趋势分析. 华西医学, 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. 肺韧带影像学. 中国医学影像技术, 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. 陈亮,王俊,吴卫兵,等. 胸腔镜精准肺段切除术技术流程和质量控制. 中国胸心血管外科临床杂志, 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

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