Abstract
Background Incomplete interlobar fissure may increase the difficulty of thoracoscopic lobectomy.
Herein, we compared the accuracy of visual versus quantitative analysis to predict
fissure integrity in lung cancer patients undergoing thoracoscopic lobectomy and evaluated
the effects of fissure integrity on surgical outcome.
Methods This was a single-center retrospective study including consecutive patients undergoing
VATS (video-assisted thoracoscopic surgery) lobectomy for lung cancer. The target
interlobar fissures were classified as complete or incomplete by visual and quantitative
analysis. Using the intraoperative finding as the reference method, the diagnostic
accuracy of the two methods to define fissure completeness (dependent variable) was
calculated and statistically compared. Yet, we evaluated differences in postoperative
outcomes between patients with complete and incomplete fissure integrity.
Results A total of 93 patients were included in the study; 33/93 (36%) presented complete
fissure. Visual and quantitative analyses correctly identified complete fissure in
19/33 (57%) and 29/33 (88%) patients, respectively, and incomplete fissure in 56/60
(93%) and 58/60 (96%) patients, respectively. Quantitative analysis had better diagnostic
accuracy than visual analysis (81 vs. 93%; p = 0.01). Patients with incomplete fissure compared with those with complete fissure
had a higher conversion rate (6 vs. 13%; p = 0.43), higher persistent air leak rate (0/33 vs. 14/60; p = 0.03), and longer hospitalization (12.6 ± 3.8 vs. 7.1 ± 2.4 days; p = 0.01).
Conclusion Quantitative analysis accurately predicted the fissures' integrity; it may be useful
for selecting suitable cases for thoracoscopic lobectomy especially for surgeons with
limited minimally invasive experience.
Keywords
computed tomography - CT scan - lung cancer - minimally invasive surgery - thoracoscopy
- VATS
