Effectiveness of free pericardial fat pad reinforcement for air leak control in pulmonary lobectomy

Intraoperative management of air leak is essential for favorable recovery after lung cancer resection. We present our approach using a free pericardial fat pad (FPFP) for injured lung parenchyma and analyze the postoperative course and radiological changes over time to evaluate the usefulness of this method.

From January 2020 to December 2023, 345 pulmonary lobectomies were performed for primary lung cancer. Postoperative course was compared between patients who received an FPFP for intraoperative air leak management (FPFP group, n = 63) and those managed without an FPFP (non-FPFP group, n = 282). Time-dependent radiological changes in the implanted FPFP were evaluated in 47 patients with computed tomography scans available at 6, 12, and 24 months postoperatively.

Although the drainage duration differed significantly between the FPFP and non-FPFP groups (P = 0.001), the postoperative hospital stay (P = 0.257) and occurrence of prolonged air leak (P = 0.163) were comparable. Radiological analysis showed that the implanted FPFP gradually shrank over time (P < 0.001). Despite this change, no complications related to FPFP shrinkage were observed.

Harvesting and implanting the FPFP was straightforward and easy to perform. Although the implanted FPFP gradually decreased in size on computed tomography, this did not adversely affect the postoperative course. FPFP application is a promising clinical option for managing intraoperative air leak in pulmonary lobectomy.