Comparison of Margin Quality for Intersegmental Plan Identification in Pulmonary Segmentectomy

Background and Objectives: Insufficient margin in lung cancer is associated with an increased locoregional recurrence rate. In pulmonary segmentectomy, two commonly used methods for identifying the intersegmental plane are inflation-deflation and indocyanine green dyeing. The aim of this study was to compare these two methods in terms of quality margins and to evaluate their superiority. Materials and Methods: A total of 63 patients who underwent segmentectomy via video-assisted thoracoscopic surgery (VATS) for pulmonary nodules and underwent preoperative planning with 3D modeling between October 2020 and February 2024 were included in this study. The location of the nodule and the distance to the intersegmental margins were virtually measured preoperatively using an open-source 3D modeling system. Patients were grouped according to the method of identifying the intersegmental margins. Group 1 included segmentectomies performed by the inflation-deflation method (n = 42), and Group 2 included segmentectomies performed by systemic indocyanine green (ICG) injection (n = 21). The area where the histopathological nodule was measured closest to the intersegmental margin was recorded. Values within (+/-10 mm) compared to the value measured in the three-dimensional model were considered successful. The obtained data were statistically compared between the groups. Results: There was no difference between the groups in terms of virtual and pathological margins. However, in terms of margin quality, the rate of deviation detected in the pathological margin compared to the measured virtual margin was significantly different between the groups (p = 0.04). Accordingly, the success rate was 64.3% in Group 1 and 90.5% in Group 2 (p = 0.05). In Group 1, the failure rate was highly against the adjacent parenchyma. There was no significant difference between the groups in the analysis of simple and complex segmentectomies. Conclusions: Intersegmental plane identification with indocyanine green increases the margin quality by defining resection margins closer to the virtual margins. In the inflation-deflation method, unnecessary parenchymal loss occurs due to disadvantages in identifying intersegmental margins.