Discussion
postoperative pain, postoperative lung re-expansion, atelectasis, lung cancer, cough, early-stage lung cancer, empyema, shortness of breath
PLEURAL EFFUSION, POSTOPERATIVE COMPLICATIONS, ATELECTASIS, LUNG CANCER, PULMONARY ATELECTASIS, EMPYEMA, COMPLICATIONS
The division of IPL during TUL remains a subject of ongoing debate. Historically, numerous thoracic surgeons held the belief that dissecting IPL during upper lobectomy could promote the expansion of the residual lobe, potentially reducing the postoperative thoracic dead space volume and preventing complications like atelectasis, pleural effusion, and empyema [Previous literature has shown that about 90% of patients can recover their lung function to the expected value within 3–6 months after surgery [Pulmonary volumetry enables objective and accurate observation of postoperative lung re-expansion. Moon et al. [The conventional view suggests that IPL preservation during upper lobectomy can lead to various postoperative complications such as apical dead space, pulmonary atelectasis, pleural effusion, and other issues [Since systematic mediastinal lymph node dissection is recommended as the standard procedure following lobectomy for resectable lung cancer, IPL is often divided to enable a more thorough lymph node dissection that includes the lower mediastinal lymph nodes. With the wide application of low-dose spiral CT, an increasing number of individuals are being screened for early-stage lung cancer through routine physical examinations [The strength of this trial lies in its status as the first multicenter prospective randomized controlled study investigating the management of IPL during TUL, thus providing a valuable reference for the procedure. However, there are still several limitations to this study. Firstly, the participating surgeons were drawn from three different medical centers, which might have resulted in slight variations in their surgical techniques. Nevertheless, these surgeons had extensive experience and had shared their surgical techniques for an extended period, ensuring a high degree of similarity in surgical approaches across institutions. Secondly, this study exclusively focuses on objective indicators and did not record subjective symptoms, such as postoperative pain, persistent cough, and shortness of breath, due to their difficulty in quantification. Thirdly, we did not extensively record the preoperative FEV1 and ASA/ECOG scores, potentially introducing reporting bias. Nonetheless, it is essential to emphasize that all enrolled patients met the inclusion criteria and fulfilled the necessary physical requirements for surgery. Lastly, to minimize bias, this study exclusively enrolled patients who underwent thoracoscopic surgery, which means the findings may not be directly applicable to open surgery cases.