Clinical impact of surgical approaches on early-phase postoperative air leakage

This study was performed to assess the impact of different surgical approaches on postoperative air leak and outcomes in patients undergoing pulmonary resection. This was a post hoc analysis of the ILO1805 trial, a multicenter prospective observational study conducted across 21 Japanese institutions. Data from 1168 patients who underwent anatomical pulmonary resection with a skin incision of ≤ 8 cm were analyzed. Patients were grouped based on the surgical approach: thoracoscopic surgery or minimally invasive open surgery. Propensity score matching was used to balance the groups. Logistic regression models were employed to identify independent factors associated with early-phase postoperative air leakage (E-AL). E-AL was observed in 290 (24.8%) patients. Factors associated with leakage included male sex (p < 0.001), body mass index of < 18.5 kg/m² (p = 0.023), pleural adhesions (p < 0.001), and the use of fibrin sealant (p < 0.001). The incidence of E-AL was significantly higher in the thoracoscopic surgery group than in the minimally invasive open surgery group (33.8% vs. 16.9%, p < 0.001). The durations of air leakage and drainage were significantly shorter in the minimally invasive open surgery group (p = 0.008 and p < 0.001, respectively). Male sex, body mass index of < 18.5 kg/m², pleural adhesions, thoracoscopic surgery, and fibrin sealant use were associated with E-AL. Minimally invasive open surgery may more effectively control E-AL, leading to shorter durations of postoperative air leakage and drainage.