Reduction of air leakage using linear staple device with bioabsorbable polyglycolic acid felt for pulmonary lobectomy.

OBJECTIVE

Pulmonary fistula is a common complication in pulmonary lobectomy for non-small cell lung cancer (NSCLC). Although a linear staple device with bioabsorbable polyglycolic acid (PGA) is used for pulmonary wedge resection with fragile pulmonary parenchyma, the efficacy of the stapler with PGA for dividing incomplete interlobular fissure in pulmonary lobectomy has not been elucidated. This study aimed to evaluate the usefulness of the stapler with PGA in reducing postoperative air leakage when dividing incomplete interlobular fissure in pulmonary lobectomy for NSCLC.

METHODS

A total of 546 patients who underwent radical lobectomy for NSCLC were analyzed retrospectively. Propensity score analysis generated two matched pairs of 125 patients in both stapler and stapler with PGA groups.

RESULTS

After propensity score matching, postoperative air leakage following pulmonary lobectomy was significantly less frequent in the stapler with PGA group (9.6%) than in the stapler group (22.4%, p = 0.006). Intraoperative additional management of PGA and/or fibrin glue was decreased in the stapler with PGA group (56.0% vs. 70.4%, p = 0.018, 54.4% vs. 69.6%, p = 0.013, respectively). On logistic regression analysis, stapler with PGA was an independent factor for preventing postoperative air leakage (odds ratio, 0.38; p = 0.015).

CONCLUSIONS

Using the stapler with PGA to divide the incomplete interlobular fissure in pulmonary lobectomy reduced postoperative air leakage, and decreased the need for additional intraoperative management using fibrin glue.