Division of the inferior pulmonary ligament during upper lobectomy does not improve postoperative pulmonary function: a systematic review and meta-analysis of observational studies and randomized controlled trials.

Background: Some surgeons routinely divide the inferior pulmonary ligament (IPL) during upper lobectomy. Nevertheless, the evidence remains inconclusive regarding whether dividing the IPL improves the postoperative pulmonary. This systematic review and meta-analysis aimed to assess the effects of inferior pulmonary ligament division (IPLD) during upper lobectomy.

Methods: Literature comparing IPLD and inferior pulmonary ligament preservation (IPLP) was identified and screened electronically from multiple electronic databases (data up to Nov 24. 2024). Postoperative changes in lung volume, bronchial angle, and drainage time (chest tube removed time), incidence of dead space, and postoperative pneumonia were assessed using Review Manager 5.4.1.

Results: 9 studies were identified, including two randomized controlled trials and seven retrospective case-control studies involving 1,612 patients. The present study demonstrated that: (1) IPLD may not improve dead space and lung volume after upper lobectomy. (2) IPLD significantly increased bronchial angle change after upper lobectomy on the left side while showing a tendency to increase bronchial angle change on the right side (3) IPLD did not have a statistically significant effect on postoperative drainage time and also did not reduce postoperative pneumonia.

Conclusion: IPLD for pulmonary function protection is unnecessary in upper lobectomy.