Does Fissureless Videothoracoscopic Lobectomy Help for Postoperative Air Leak?

 

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Abstract

Background Postoperative air leak is a common problem in patients undergoing pulmonary resections. A conventional fissure dissection technique during videothoracoscopic lobectomy, particularly in patients with fused fissures is very likely to result in parenchymal damage and prolonged air leak (PAL). In contrast, fissureless video-assisted thoracoscopic surgery (VATS) lobectomy may have advantages regarding PAL and hospital stay.

Methods We conducted a retrospective study consisting of 103 consecutive patients who underwent a VATS lobectomy either with a conventional or fissureless technique and statistically analyzed the results particularly with respect to PAL, chest tube duration (CTD), and length of hospital stay (LOS).

Results We had 21 (20.4%) cases with PAL. Gender (p = 0.009), histological size of tumor (p = 0.003), and surgical technique (p = 0.009) showed statistically significant differences for PAL in contingency tables. Significant predictors for PAL in univariate analysis were male sex (p = 0.017), histological size of tumor more than 24 mm (p = 0.005), and conventional technique (p = 0.017). Similarly, multivariate analysis revealed male sex (p = 0.036), histological size of tumor more than 24 mm (p = 0.043), and conventional technique (p = 0.029) as significant predictors for PAL. In addition, both the medians of CTD (p = 0.015) and LOS (p = 0.005) were comparably lesser as 3 days, in patients who underwent fissureless videothoracoscopic lobectomy.

Conclusion The fissureless technique helps for PAL in patients undergoing videothoracoscopic lobectomy.

Publication History

Received: 18 August 2022

Accepted: 24 November 2022

Article published online:
24 January 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

• References

• 1 Brunelli A, Cassivi SD, Halgren L. Risk factors for prolonged air leak after pulmonary resection. Thorac Surg Clin 2010; 20 (03) 359-364
  CrossrefPubMedGoogle Scholar
• 2 Stamenovic D, Bostanci K, Messerschmidt A, Jahn T, Schneider T. Fissureless fissure-last video-assisted thoracoscopic lobectomy for all lung lobes: a better alternative to decrease the incidence of prolonged air leak?. Eur J Cardiothorac Surg 2016; 50 (01) 118-123
  CrossrefPubMedGoogle Scholar
• 3 Nomori H, Ohtsuka T, Horio H, Naruke T, Suemasu K. Thoracoscopic lobectomy for lung cancer with a largely fused fissure. Chest 2003; 123 (02) 619-622
  CrossrefPubMedGoogle Scholar
• 4 Balsara KR, Balderson SS, D'Amico TA. Surgical techniques to avoid parenchymal injury during lung resection (fissureless lobectomy). Thorac Surg Clin 2010; 20 (03) 365-369
  CrossrefPubMedGoogle Scholar
• 5 Gómez-Caro A, Calvo MJR, Lanzas JT, Chau R, Cascales P, Parrilla P. The approach of fused fissures with fissureless technique decreases the incidence of persistent air leak after lobectomy. Eur J Cardiothorac Surg 2007; 31 (02) 203-208
  CrossrefPubMedGoogle Scholar
• 6 Kozower BD. Complications of thoracic surgical procedures. In: Locicero J, Feins RH, Colson YL, Rocco G, eds. Shields' General Thoracic Surgery. Philadelphia, PA: Wolters Kluwer; 2019: 1212
  Google Scholar
• 7 Burt BM, Shrager JB. Prevention and management of postoperative air leaks. Ann Cardiothorac Surg 2014; 3 (02) 216-218
  PubMedGoogle Scholar
• 8 Huang W, Wang WR, Deng B. et al. Several clinical interests regarding lung volume reduction surgery for severe emphysema: meta-analysis and systematic review of randomized controlled trials. J Cardiothorac Surg 2011; 6: 148
  CrossrefPubMedGoogle Scholar
• 9 Merritt RE, Singhal S, Shrager JB. Evidence-based suggestions for management of air leaks. Thorac Surg Clin 2010; 20 (03) 435-448
  CrossrefPubMedGoogle Scholar
• 10 Ng T, Ryder BA, Machan JT, Cioffi WG. Decreasing the incidence of prolonged air leak after right upper lobectomy with the anterior fissureless technique. J Thorac Cardiovasc Surg 2010; 139 (04) 1007-1011
  CrossrefPubMedGoogle Scholar
• 11 Refai M, Brunelli A, Salati M, Pompili C, Xiumè F, Sabbatini A. Efficacy of anterior fissureless technique for right upper lobectomies: a case-matched analysis. Eur J Cardiothorac Surg 2011; 39 (06) 1043-1046
  CrossrefPubMedGoogle Scholar
• 12 Stamenovic D, Bostanci K, Messerschmidt A, Tillmann J, Kostic M, Schneider T. Fissure-last video-assisted thoracoscopic lobectomy for ‘non-upper’ lobes. ANZ J Surg 2017; 87 (12) 1021-1025
  CrossrefPubMedGoogle Scholar
• 13 Paydar S, Ghahramani Z, Ghoddusi Johari HG. et al. Tube thoracostomy (chest tube) removal in traumatic patients: what do we know? What can we do?. Bull Emerg Trauma 2015; 3 (02) 37-40
  PubMedGoogle Scholar
• 14 Cerfolio RJ, Bryant AS. Results of a prospective algorithm to remove chest tubes after pulmonary resection with high output. J Thorac Cardiovasc Surg 2008; 135 (02) 269-273
  CrossrefPubMedGoogle Scholar
• 15 Stamenovic D, Dusmet M, Schneider T, Roessner E, Messerschmidt A. A simple size-tailored algorithm for the removal of chest drain following minimally invasive lobectomy: a prospective randomized study. Surg Endosc 2022; 36 (07) 5275-5281
  CrossrefPubMedGoogle Scholar
• 16 Bjerregaard LS, Jensen K, Petersen RH, Hansen HJ. Early chest tube removal after video-assisted thoracic surgery lobectomy with serous fluid production up to 500 ml/day. Eur J Cardiothorac Surg 2014; 45 (02) 241-246
  CrossrefPubMedGoogle Scholar