Continuous suture ligation of segmental hilar structures is associated with reduced prolonged air leak after...

Segmentectomy has gained increasing acceptance as a surgical option for early-stage non-small cell lung cancer. However, segmentectomy is considered to be associated with a higher incidence of prolonged air leak (PAL) compared with lobectomy. Although PAL is rarely life-threatening, it is consistently associated with prolonged hospital length of stay and higher healthcare costs. Several methods have been developed to reduce the incidence of PAL, including the application of surgical sealants and modified surgical techniques such as pleural tenting. This study aims to evaluate the efficacy and safety of a segmentectomy technique involving continuous ligation of the segmental hilar structures (SHS) to prevent PAL.

We conducted a retrospective comparative cohort study including consecutive patients who underwent anatomical segmentectomy between December 1, 2023 and December 31, 2025 in The First Affiliated Hospital of Soochow University. Patients were divided into two groups based on the intraoperative use of continuous suture ligation for the SHS during anatomical segmentectomy. SHS were defined as the anatomical region comprising the segmental artery, segmental bronchus and adjacent pulmonary parenchyma. PAL was defined as a continuous air leakage for more than 5 days.

A total of 240 patients were included in this study: 101 in the suture group and 139 in the control group. After propensity score matching (PSM), 78 patients were included in each group. The median duration of chest tube placement was shorter in the suture group than in the control group {3 [interquartile range (IQR), 2-4] vs. 4 (IQR, 3-5) days, P=0.001}. Patients in the suture group had a shorter postoperative air leakage duration than that in the control group [1 (IQR, 0-2) vs. 1 (IQR, 0-3) days, P=0.001]. The 24 h chest tube drainage after surgery was significantly lower in the suture group than in the control group [50 (IQR, 30-100) vs. 90 (IQR, 50-120) mL, P=0.001]. The absolute risk reduction of PAL was 11.5 percentage points (P=0.01), and both the exact matched analysis (P=0.01) and conditional logistic regression (P=0.03) supported lower odds of PAL after suture ligation.

In this retrospective study, continuous suture ligation of the SHS demonstrated potential efficacy in preventing PAL and reducing postoperative thoracic drainage volume following segmentectomy. Application of this technique was associated with a lower incidence of PAL, as well as shorter chest tube duration and reduced length of hospital stay.