Inferior pulmonary ligament preservation improves early residual lung compensatory function particularly after right upper lobectomy: a prospective randomized controlled trial
In brief
Preserving the lung ligament cut 1-month FEV1 loss by 0.33 L after right upper lobectomy
In a randomized trial of 66 patients, those whose lung ligament was preserved lost 0.33 L less forced expiratory volume in one second at 1 month after right upper lobectomy than those whose ligament was divided. Recovery was also faster, but no benefit appeared after left upper lobectomy; larger studies are needed to confirm the side-specific finding.
- Journal
- Surgical endoscopy (Q1)
- Published
- 5 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Juyi Hu, Maodan Chen, Yang Huang, Wenfei Zhu, Zewei Li, Bingyu Rao, et al.
- PMID
- 42834183
- DOI
- 10.1007/s00464-026-13387-z
Why clinicians should know about it
- Picked for Anatomy (paper of the day, 7 October 2026): Preservation of IPL improves early lung function after lobectomy
Abstract
BACKGROUND: Compensatory lung expansion following lobectomy is essential for functional recovery. Division of the inferior pulmonary ligament (IPL) during thoracoscopic upper lobectomy is commonly performed to facilitate residual lung expansion, yet its efficacy remains unproven, and the procedure may compromise bronchial anatomy. We conducted a prospective randomized controlled trial to evaluate the impact of IPL preservation versus division on postoperative pulmonary compensation using quantitative three-dimensional (3D) functional lung volume (FLV) analysis. METHODS: Patients undergoing thoracoscopic upper lobectomy for non-small cell lung cancer were intraoperatively randomized to IPL preservation (group P, n=33) or division (group D, n=33). Primary outcomes included FLV and forced expiratory volume in one second (FEV₁) at 1, 3, and 6 months postoperatively. Secondary outcomes comprised residual bronchial angles, residual thoracic cavity rate, total lung volume, perioperative parameters, and comparison of residual lung volume. RESULTS: After right upper lobectomy, group P had significantly less 1-month FLV loss (- 420±312 mL vs. -488±283 mL, P=0.027) and FEV₁ loss (- 0.46±0.28 L vs. -0.79±0.33 L, P=0.035), plus faster recovery between 1 and 3 months (all P<0.05). Residual bronchial angle changes were significantly smaller in group P at 1 month (14.5±9.2° vs. 19.3±10.5°, P=0.036) and 3 months (18.4±8.2° vs. 23.2±9.8°, P=0.047). Postoperative hospital stay was shorter in group P (4.7±1.6 days vs. 5.8±1.4 days, P=0.046). No significant differences were seen in residual cavity rate, total lung volume, or any outcome after left upper lobectomy. CONCLUSIONS: Preservation of the IPL during thoracoscopic upper lobectomy mitigates early pulmonary function decline, accelerates compensatory recovery, and maintains bronchial stability following right upper lobectomy, without increasing complications. These findings support selective IPL preservation to improve early postoperative recovery, particularly in right-sided resections.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.