Systematic or On-Demand Sealant Use in Minimally Invasive Lung Surgery: A Matched Comparison

Prolonged air leak remains a major concern following minimally invasive lung cancer surgery. This study aimed to evaluate whether the systematic use of aerostatic sealants improves postoperative outcomes compared to an on-demand strategy.

Over a 12-month period, we selected patients underwent anatomical lung resection with minimally invasive techniques for lung cancer. Before March 2023, patients received an absorbable polyglycolic acid patch selectively based on intraoperative findings (on-demand group). Thereafter, a cohort of consecutive patients received a polyethylene glycol sealant systematically (systematic group). Patients matched 1:1 using a propensity score based on type of resection, surgical approach, Forced Expiratory Volume, Chronic Obstructive Pulmonary Disease and Diffusing Capacity of the Lung. The primary end-point was length of hospital stay. Secondary end-points included duration of chest tube drainage, redrainage or blood patch, postoperative complications, and 90-day readmission.

Two hundred and thirty patients were selected, 164 in on-demand group, and 66 in systematic group; After matching, there were 56 patients in each group. Preoperative baseline characteristics were similar between group. Sealants were used in 100% of patients in the systematic group versus 13% in the on-demand group (N = 29). Median hospital stay was not significantly different (5 [IQR 4-8] vs 5.5 [IQR 3-8] days, P = 0.371). No differences were found in mean drainage duration (4 vs 4 days, P = .327), complication rate (36% vs 34%, P = .491), redrainage (8.9% vs 7.1%; P = .999), or prolonged drainage (13% vs 14%, P = .781). Ninety-day readmission was not significantly different between groups (11% vs 2%, P = .113).

This study revealed no statistically significant differences between the 2 strategies.