Červeňák Vladimír, Chovanec Zdeněk, Berková Alena, Cimflová Petra, Kelblová Martina, Čundrle Ivan, Hanslík Tomáš, Resler Jan, Součková Lenka, Jankaničová Natália, Vaníček Jiří
Department of Medical Imaging, St. Anne's University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czechia.
1st Department of Surgery, St. Anne's University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czechia.
Front Oncol. 2024 May 21;14:1392398. doi: 10.3389/fonc.2024.1392398. eCollection 2024.
Subpleural located pulmonary nodules are perioperatively invisible to the surgeon. Their precise identification is conventionally possible by palpation, but often at the cost of performing a thoracotomy. The aim of the study was to evaluate the success rate and feasibility of the pre-operative CT-guided marking subpleural localized nodule using a mixture of Patent Blue V and an iodine contrast agent prior to the extra-anatomical video-assisted thoracoscopic surgery (VATS) resection in patients for whom the primary anatomical resection in terms of segmentectomy or lobectomy was not indicated.
The data of consecutive patients with pulmonary nodules located ≤ 30 mm from the parietal pleura, who were indicated for VATS extra-anatomical resection between 2017 to 2023, were retrospectively reviewed and analyzed. All patients indicated for VATS resection underwent color marking of the area with the pulmonary lesion under CT-guided control immediately before the surgery. The primary outcome was the marking success. Morphological lesion characteristics, time from marking to the surgery, procedure related complications, final histology findings and 30day mortality were analyzed. Additionally, we assessed the association of the successful marking and the patient's smoking history.
A total of 62 lesions were marked. The successful marking was observed in 56/62 (90.3%) patients. The median time from the lesion marking to the beginning of surgery was 75.0 (IQR 65.0-85.0) minutes. The procedure related pneumothorax was observed in 6 (9.7%) patients, intraparenchymal hematoma in 1 (1.6%) patient. No statistically significant association of the depth of the subpleural lesion's location, occurrence of complications or time from the marking to surgery and the successful marking was observed. The 30day mortality was zero. No association of smoking and successful marking was observed.
The method of marking the subpleural pulmonary lesions under CT-guided control with a mixture of Patent Blue V and iodine contrast agent is a safe and effective method with minimal complications. It provides surgeons the precise visualization of the affected pulmonary parenchyma before the planned extra-anatomical VATS resection.
位于胸膜下的肺结节在手术过程中外科医生无法直接看到。传统上，通过触诊可以精确识别这些结节，但通常需要进行开胸手术。本研究的目的是评估在非解剖性电视辅助胸腔镜手术（VATS）切除术前，使用专利蓝V和碘造影剂混合物对胸膜下局限性结节进行CT引导下标记的成功率和可行性，这些患者不适合进行肺段切除术或肺叶切除术等主要解剖性切除。
回顾性分析2017年至2023年间连续入选的、距脏层胸膜≤30mm的肺结节患者资料，这些患者拟行VATS非解剖性切除。所有拟行VATS切除的患者在手术前立即在CT引导下对肺部病变区域进行彩色标记。主要结局是标记成功。分析病变形态特征、标记至手术的时间、手术相关并发症、最终组织学结果和30天死亡率。此外，我们评估了成功标记与患者吸烟史之间的关联。
共标记了62个病变。56/62（90.3%）例患者标记成功。从病变标记到手术开始的中位时间为75.0（四分位间距65.0 - 85.0）分钟。6（9.7%）例患者发生手术相关气胸，1（1.6%）例患者发生实质内血肿。未观察到胸膜下病变位置深度、并发症发生情况或标记至手术时间与成功标记之间存在统计学显著关联。30天死亡率为零。未观察到吸烟与成功标记之间存在关联。
在CT引导下用专利蓝V和碘造影剂混合物标记胸膜下肺部病变的方法是一种安全有效的方法，并发症极少。它为外科医生在计划的非解剖性VATS切除术前提供了受影响肺实质的精确可视化。
