Background The clinical benefit of dividing the inferior pulmonary ligament (IPL) during video-assisted thoracoscopic upper lobectomy (TUL) for early-stage lung cancer remains controversial. This study aimed to evaluate the association between IPL division during TUL and postoperative clinical outcomes. Methods We retrospectively analyzed 95 patients who underwent TUL between December 2020 and June 2025. Patients were assigned to an IPL-preservation group (Group P) or an IPL-division group (Group D). Group P included 50 patients (31 right-sided and 19 left-sided procedures), and Group D included 45 (29 right-sided and 16 left-sided procedures). Postoperative outcomes—including operative time, intraoperative blood loss, duration of postoperative air leak, chest tube duration, length of postoperative hospital stay, and changes in bronchial angle, lung volume, pulmonary function, and cough severity—were compared between groups. Bronchial angle and lung volume were measured using three-dimensional (3D) reconstructed chest computed tomography (CT) images. Cough severity and cough-related quality of life before and after surgery were assessed using the Mandarin Chinese version of the Leicester Cough Questionnaire (LCQ-MC). Results Baseline characteristics were comparable between groups, with no statistically significant differences (all P 0.05). IPL division was associated with a greater degree of postoperative bronchial angle change after left-sided surgery, reaching borderline significance at 3 months (68.1 ± 7.2° vs. 78.1 ± 7.8°, P = 0.046) and poorer 6-month outcomes, including smaller lung volume (3615 ± 475 mL vs. 3392 ± 489 mL, P = 0.027), a trend towards lower FEV1% (73.04 ± 9.36 vs. 69.06 ± 10.11, P = 0.049), lower DLCO (80.82 ± 10.35 vs. 76.06 ± 11.08, P = 0.033), and lower total LCQ-MC score (17.70 ± 1.72 vs. 16.98 ± 1.69, P = 0.042). No significant between-group differences were observed for other endpoints. Conclusions IPL division did not demonstrate a clear benefit over IPL preservation. The findings suggest that IPL division may be associated with reduced postoperative lung volume, impaired recovery of diffusing capacity, greater displacement of the residual bronchus, and more severe chronic cough. However, particularly for outcomes with marginally significant P values, these results should be interpreted with caution due to multiple comparisons. These conclusions are hypothesis-generating and require confirmation in larger, prospective studies.
Huang et al. (Mon,) studied this question.