Material Use for Air Leakage Prevention Post-Lung Resection: Insights from Real-World Data in Japan

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Pulmonary Medicine

Background:

• Lung resection is a primary treatment for localized lung cancer.
• Prolonged air leakage is a frequent complication, leading to significant health and economic burdens.
• Current data on the real-world use of interventions like staplers, sealants, and adjunctive materials is limited.

Purpose of the Study:

• To investigate the real-world utilization patterns of intraoperative adjunctive materials during lung resection for primary lung cancer in Japan.
• To assess the association between the use of these materials and patient characteristics, comorbidities, and postoperative outcomes.

Main Methods:

• A retrospective analysis of a Japanese hospital database (2015-2020) including 393 hospitals.
• Identification of patients undergoing lobectomy, segmentectomy, or partial resection for primary lung cancer.
• Evaluation of intraoperative use of staple-line buttresses, fibrin glue, polyglycolic acid (PGA) sheets, and other materials, comparing patient characteristics and prolonged postoperative drainage (≥7 days).

Main Results:

• Buttress use was low across procedures (2.2%-6.4%).
• Patients receiving buttresses or PGA plus fibrin glue had higher rates of emphysema and interstitial pneumonia.
• Prolonged drainage occurred frequently (6.9% stapler-only vs. 24.8% buttress in lobectomy) and nearly doubled in-hospital costs.

Conclusions:

• Prolonged air leakage is a significant complication of lung resection, carrying clinical and economic weight.
• This study offers a nationwide perspective on the real-world application of adjunctive materials in lung cancer surgery.
• Further research may be needed to optimize the use of these materials to reduce complications and costs.