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DOI: 10.1055/s-0042-1755382
The Prediction of Fissure Integrity by Quantitative Computed Tomography Analysis
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 - VATSPublikationsverlauf
Eingereicht: 15. April 2022
Angenommen: 27. Juni 2022
Artikel online veröffentlicht:
20. August 2022
© 2022. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
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References
- 1 NCCN. Accessed July 17, 2022 at: https://www.nccn.org/patients/guidelines/content/PDF/lung-early-stage-patient.pdf
- 2 NICE Accessed July 17, 2022 at: https://www.nice.org.uk/guidance/NG122
- 3 ASCO. Accessed July 17, 2022 at: http://ascopubs.org/doi/suppl/10.1200/JCO.2017.74.6065/suppl_file/ms_2017.74.6065.pdf
- 4 Lim E, Batchelor T, Shackcloth M. et al; VIOLET Trialists. Study protocol for VIdeo assisted thoracoscopic lobectomy versus conventional Open LobEcTomy for lung cancer, a UK multicentre randomised controlled trial with an internal pilot (the VIOLET study). BMJ Open 2019; 9 (10) e029507
- 5 Li S, Zhou K, Wang M, Lin R, Fan J, Che G. Degree of pulmonary fissure completeness can predict postoperative cardiopulmonary complications and length of hospital stay in patients undergoing video-assisted thoracoscopic lobectomy for early-stage lung cancer. Interact Cardiovasc Thorac Surg 2018; 26 (01) 25-33
- 6 Lee S, Lee JG. The significance of pulmonary fissure completeness in video-assisted thoracoscopic surgery. J Thorac Dis 2019; 11 (Suppl 3): S420-S421
- 7 Koenigkam-Santos M, Puderbach M, Gompelmann D. et al. Incomplete fissures in severe emphysematous patients evaluated with MDCT: incidence and interobserver agreement among radiologists and pneumologists. Eur J Radiol 2012; 81 (12) 4161-4166
- 8 Fiorelli A, Santini M, Shah P. When can computed tomography-fissure analysis replace Chartis collateral ventilation assessment in the prediction of patients with emphysema who might benefit from endobronchial valve therapy?. Interact Cardiovasc Thorac Surg 2018; 26 (02) 313-318
- 9 Fiorelli A, Poggi C, Anile M. et al. Visual analysis versus quantitative CT analysis of interlobar fissure integrity in selecting emphysematous patients for endobronchial valve treatment. Interact Cardiovasc Thorac Surg 2019; 28 (05) 751-759
- 10 Clavien PA, Barkun J, de Oliveira ML. et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 2009; 250 (02) 187-196
- 11 StratX. Accessed July 17, 2022 at: https://www.pulmonxstratx.com/
- 12 Hansen HJ, Petersen RH. Video-assisted thoracoscopic lobectomy using a standardized three-port anterior approach - the Copenhagen experience. Ann Cardiothorac Surg 2012; 1 (01) 70-76
- 13 Falcoz PE, Puyraveau M, Thomas PA. et al; ESTS Database Committee and ESTS Minimally Invasive Interest Group. Video-assisted thoracoscopic surgery versus open lobectomy for primary non-small-cell lung cancer: a propensity-matched analysis of outcome from the European Society of Thoracic Surgeon database. Eur J Cardiothorac Surg 2016; 49 (02) 602-609
- 14 Lee S, Lee JG, Lee CY, Kim DJ, Chung KY. Pulmonary fissure development is a prognostic factor for patients with resected stage I lung adenocarcinoma. J Surg Oncol 2016; 114 (07) 848-852
- 15 Craig SR, Walker WS. A proposed anatomical classification of the pulmonary fissures. J R Coll Surg Edinb 1997; 42 (04) 233-234
- 16 Li S, Wang Z, Zhou K. et al. Effects of degree of pulmonary fissure completeness on major in-hospital outcomes after video-assisted thoracoscopic lung cancer lobectomy: a retrospective-cohort study. Ther Clin Risk Manag 2018; 14: 461-474
- 17 Tong C, Li T, Huang C. et al. Risk factors and impact of conversion to thoracotomy from 20,565 cases of thoracoscopic lung surgery. Ann Thorac Surg 2020; 109 (05) 1522-1529
- 18 Sezen CB, Bilen S, Kalafat CE. et al. Unexpected conversion to thoracotomy during thoracoscopic lobectomy: a single-center analysis. Gen Thorac Cardiovasc Surg 2019; 67 (11) 969-975
- 19 Schieman C, MacGregor JH, Kelly E. et al. Can preoperative computed tomography of the chest predict completeness of the major pulmonary fissure at surgery?. Can J Surg 2011; 54 (04) 252-256
- 20 Kent MS, Ridge C, O'Dell D, Lo P, Whyte R, Gangadharan SP. The accuracy of computed tomography to predict completeness of pulmonary fissures. A prospective study. Ann Am Thorac Soc 2015; 12 (05) 696-700
- 21 Hishida T. Video-assisted thoracoscopic lung cancer lobectomy for patients with incomplete interlobar fissure: is it a safe and reasonable procedure?. J Thorac Dis 2018; 10 (Suppl 26): S3056-S3057
- 22 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
- 23 West CT, Slim N, Steele D, Chowdhury A, Brassett C. Are textbook lungs really normal? A cadaveric study on the anatomical and clinical importance of variations in the major lung fissures, and the incomplete right horizontal fissure. Clin Anat 2021; 34 (03) 387-396
- 24 Murlimanju BV, Prabhu LV, Shilpa K. et al. Pulmonary fissures and lobes: a cadaveric study with emphasis on surgical and radiological implications. Clin Ter 2012; 163 (01) 9-13