Efficacy, safety and patient satisfaction of two-stage versus single-stage computed tomography guided localization and resection of pulmonary nodules.

BACKGROUND

Low-dose computed tomography (CT) has been increasingly utilized for lung cancer screening. Localization of solitary pulmonary nodules (SPN) is crucial for resection. Two-stage localization method involves dye injection by radiologists prior to the operation. The significant interval between localization and resection is associated with a higher risk of marker failure, psychological distress and procedural complications. Single-stage localization and resection procedure under general anesthesia poses unique challenges. The aim of the study is to compare the safety, efficacy and patient satisfaction between the two methods.

METHODS

This is a retrospective study comparing outcomes between two-stage and single-stage pre-operative localization of SPN. The primary study outcome was total operating time. Secondary outcomes included successful lesion localization, complication rate, 30-day readmission, mortality, patient satisfaction, and pain level.

RESULTS

A total of 26 and 56 patients were included for the single and two-stage group respectively. Total operative time was significantly longer in the single-stage arm (mean: 188 min) than that of the two-stage arm (mean: 172 min, P<0.001) due to the additional time needed for intra-operative localization. Mean satisfaction score was significantly higher in the single-stage group than that of the two-stage group (92 52.69, P=0.004). Pain level assessed by numerical rating scales was better in the single-stage arm compared to the two-stage arm (mean: 8.8 4.85, P=0.007).

CONCLUSIONS

Single-stage localization and resection resulted in a minor increase in total operative time, higher patient satisfaction and less pain with comparable safety and efficacy to conventional two-stage approach.