[Fluorescence Guided Sublobar Lung Resection by Using Three-dimensional Image Analysis and Transbronchial Instillation of Indocyanine Green].

BACKGROUND

The confirmation of an appropriate resection margin from the tumor is crucial for reducing the risk of local recurrence after sublobar resection for pulmonary malignancies.

PATIENTS AND METHODS

From October 2014 to April 2018, 66 operative cases in 64 patients( primary lung cancer 42, metastatic lung tumor 21, benign disease 3) were enrolled. In lung cancer, active limited resection was done in 29 and passive limited resection was done in 13. Preoperatively, each patient created several virtual sublobar resections by using 3-dimensional (3D) volume analyzer. We measured the surgical margin in each simulated sublobar resection and selected the most appropriate procedure. Surgical resection matched with virtual sublobar resection was done by using an infrared thoracoscopy with transbronchial indocyanine green (ICG) instillation. In lung cancer, we compared surgical outcomes between ICG cases and 47 historical segmentectomy cases.

RESULTS

The types of sublobar resection were subsegmental resection in 5, simple segmentectomy in 15, complex segmentectomy in 16 and extended segmentectomy in 22 and anatomical super deep wedge resection in 8. The shortest distance of surgical margin by simulation and an actual measurement were 20.8±11.1 mm and 22.6±8.3 mm, respectively( p=0.186). Postoperative recurrence was found in 8 cases (distant in 7 and mediastinal lymph node in 1). No locoregional recurrence was found in all cases. Postoperative recurrence was similar between the 2 groups in active and passive limited resection, respectively.

CONCLUSION

ICG-guided sublobar resection by transbronchial ICG instillation is applicable to any type of sublobar resection and can control local recurrence of lung neoplasms.