Re-appraisal of bronchus-first right upper lobectomy as an alternative routine procedure.

Objectives: Postoperative air leakage is a major complication of lung resection, particularly right upper lobectomy. However, various surgical procedures can reduce postoperative complications and shorten the drainage period. The current study aimed to analyse the utility of bronchus-first right upper lobectomy as an alternative routine procedure.

Methods: We retrospectively analysed the data of 225 (53.7%) patients who underwent bronchus-first right upper lobectomy and 194 (46.3%) patients who underwent the conventional bronchus-last right upper lobectomy at our institution from 2015 to 2022. In patients with incomplete fissures who underwent bronchus-first right upper lobectomy, the bronchus was dissected 1st, followed by the pulmonary artery and vein, and then, the interlobar fissure was divided. We compared the outcomes of 2 procedures and analysed the surgical utility of bronchus-first right upper lobectomy.

Results: The surgical outcomes and postoperative morbidity comparing bronchus-first and bronchus-last procedure were as follows: median operation time (min) 103/126 (P < 0.001), median bleeding amount (ml) 28/55 (P = 0.003), incomplete lobulation rate (%) 35.1/24.2 (P = 0.02), incidence of prolonged air leakage (%) 2.2/3.1 (P = 0.76) and rate of fellow surgeon's operation (%) 28.0/4.6 (P < 0.001). The procedure was associated with a decreased incidence of prolonged air leakage. The 4-year overall survival rates did not significantly differ between the 2 groups (P = 0.24).

Conclusions: Bronchus-first right upper lobectomy can prevent postoperative air leakage in patients with incomplete fissure. Additionally, as an alternative routine procedure, it is associated with a shorter surgical duration and a lower volume of blood loss regardless of interlobar fissure and operator's experience.