Bae Seon Yong, Yun Taeyoung, Park Ji Hyeon, Na Bubse, Na Kwon Joong, Park Samina, Lee Hyun Joo, Park In Kyu, Kang Chang Hyun, Kim Young Tae
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea.
Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Korea.
J Chest Surg. 2024 Sep 5;57(5):450-457. doi: 10.5090/jcs.24.008. Epub 2024 Apr 23.
The inflation-deflation (ID) method has long been the standard for intraoperative margin assessment in segmentectomy. However, with advancements in vision technology, the use of near-infrared mapping with indocyanine green (ICG) has become increasingly common. This study was conducted to compare the perioperative outcomes and resection margins achieved using these methods.
This retrospective study included patients who underwent direct segmentectomy for clinical stage I lung cancer between January 2018 and September 2022. We compared perioperative factors, including bronchial and parenchymal resection margins, according to the margin assessment method and the type of segmentectomy performed. Since the ICG approach was adopted in April 2021, we also examined a recent subgroup of patients treated from then onward.
A total of 319 segmentectomies were performed. ID and ICG were utilized for 261 (81.8%) and 58 (18.2%) patients, respectively. Following April 2021, 61 patients (51.3%) were treated with ID, while 58 (48.7%) received ICG. We observed no significant difference in resection margins between ID and ICG for bronchial (2.7 cm vs. 2.3 cm, p=0.07) or parenchymal (2.5 cm vs. 2.3 cm, p=0.46) margins. Additionally, the length of hospitalization and the complication rate were comparable between groups. Analysis of the recent subgroup confirmed these findings, showing no significant differences in resection margins (bronchial: 2.6 cm vs. 2.3 cm, p=0.25; parenchymal: 2.4 cm vs. 2.3 cm, p=0.75), length of hospitalization, or complication rate.
The perioperative outcomes and resection margins achieved using ID and ICG were comparable, suggesting that both methods can safely guide segmentectomy procedures.
膨胀-萎陷（ID）方法长期以来一直是肺段切除术术中切缘评估的标准。然而，随着视觉技术的进步，使用吲哚菁绿（ICG）进行近红外成像的应用越来越普遍。本研究旨在比较使用这些方法获得的围手术期结果和切除切缘。
这项回顾性研究纳入了2018年1月至2022年9月期间因临床I期肺癌接受直接肺段切除术的患者。我们根据切缘评估方法和所进行的肺段切除术类型，比较了围手术期因素，包括支气管和实质切缘。由于ICG方法于2021年4月开始采用，我们还研究了从那时起接受治疗的近期患者亚组。
共进行了319例肺段切除术。分别有261例（81.8%）和58例（18.2%）患者使用了ID和ICG。2021年4月之后，61例（51.3%）患者采用ID治疗，而58例（48.7%）接受ICG治疗。我们观察到，在支气管切缘（2.7 cm对2.3 cm，p = 0.07）或实质切缘（2.5 cm对2.3 cm，p = 0.46）方面，ID和ICG之间的切除切缘无显著差异。此外，两组之间的住院时间和并发症发生率相当。对近期亚组的分析证实了这些发现，显示在切除切缘（支气管：2.6 cm对2.3 cm，p = 0.25；实质：2.4 cm对2.3 cm，p = 0.75）、住院时间或并发症发生率方面无显著差异。
使用ID和ICG获得的围手术期结果和切除切缘相当，这表明两种方法都可以安全地指导肺段切除手术。
