Comparison of Margin Quality for Intersegmental Plan Identification in Pulmonary Segmentectomy.

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Medical Imaging

Background:

• Achieving adequate surgical margins is critical in lung cancer treatment to prevent locoregional recurrence.
• Pulmonary segmentectomy requires precise identification of intersegmental planes, with inflation-deflation and indocyanine green (ICG) dyeing being common methods.

Purpose of the Study:

• To compare the margin quality achieved by inflation-deflation versus ICG injection for identifying intersegmental planes in video-assisted thoracoscopic surgery (VATS) segmentectomy.
• To evaluate the superiority of each method in defining accurate resection margins.

Main Methods:

• A comparative study of 63 patients undergoing VATS segmentectomy for pulmonary nodules, with preoperative 3D modeling for virtual margin measurement.
• Patients were divided into two groups: inflation-deflation (n=42) and ICG injection (n=21) for intersegmental plane identification.
• Pathological margins were compared to virtual margins; success was defined as deviation within +/-10 mm.

Main Results:

• No significant difference was found in virtual versus pathological margin measurements between the groups.
• The ICG group demonstrated a significantly higher success rate (90.5%) compared to the inflation-deflation group (64.3%) in achieving desired margin quality (p=0.05).
• The inflation-deflation method was associated with greater deviation towards adjacent parenchyma, indicating potential for unnecessary tissue loss.

Conclusions:

• Indocyanine green injection enhances margin quality in pulmonary segmentectomy by enabling resection margins closer to virtual targets.
• The inflation-deflation method may lead to suboptimal margin definition and excessive parenchymal resection due to identification challenges.
• ICG is a superior method for intersegmental plane identification in VATS segmentectomy, improving resection accuracy and potentially preserving lung function.