Controversies Regarding the Management of Residual Pleural Space Following Pulmonary Lobectomy
Keywords:
residual pleural space; ; pulmonary lobectomy; prolonged air leak; pleurodesis; postoperative complicationsAbstract
Introduction: Residual pleural space following pulmonary lobectomy is a common finding, the clinical significance of which is a matter of debate, as in most cases it resolves spontaneously and may be associated with complications such as persistent air leak, empyema, or lung entrapment.
Objective: To analyze the current evidence regarding the incidence, predisposing factors, and treatment options for residual intrapleural space following lobectomy.
Methods: A review was conducted of original articles, systematic reviews, and clinical guidelines published between 2010 and 2024 in databases such as PubMed, Scopus, and SciELO. Studies with objective measurement of residual pleural volume and postoperative clinical follow-up were prioritized.
Results: The reported incidence of residual intrapleural space ranges from 10% to 66%, depending on the type of lobectomy and the diagnostic method. The main associated factors are right upper lobectomy, chronic obstructive pulmonary disease, prolonged air leak, and poor parenchymal compliance. Most mild cases can be managed conservatively under clinical and radiological surveillance. There is no international consensus on the criteria for reoperation, but intervention is generally accepted in cases of sepsis, progressive lung collapse, or a residual space > 20%.
Conclusions: Management of residual intrapleural space should be tailored to the patient’s condition and radiological course. Standardized protocols and prospective multicenter studies are needed to better define the safest and most cost-effective therapeutic strategies.
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