Effect of virtual-assisted lung mapping in acquisition of surgical margins in sublobar lung resection
Effect of virtual-assisted lung mapping in acquisition of surgical margins in sublobar lung resection
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DOI：
10.1016/j.jtcvs.2018.05.122
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发表时间：
2018-10-01
影响因子：
6
通讯作者：
Nakajima, Jun
中科院分区：
文献类型：
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作者：
Sato, Masaaki;Kobayashi, Masashi;Nakajima, Jun
目的：虚拟辅助肺标测是一种术前支气管镜多点染色技术。本研究旨在探讨虚拟辅助肺标测在叶下肺切除术中获得足够手术切缘的有效性。方法：这项多中心、前瞻性、单臂研究于2016年9月至2017年7月在19个注册中心进行。需要叶下肺切除并仔细确定切除边缘的患者接受了虚拟辅助肺标测，随后进行了胸腔镜手术。成功切除被定义为切除边缘大于病变直径或2厘米的病变，采用术前计划的切除而不进行额外切除。我们将研究的主要目标定义为实现95%的病变成功切除。结果：153例患者切除了203个病变(平均直径9.6+/-5.3 mm)。病变包括单纯性毛玻璃结节75例(35.9%)，混合性毛玻璃结节36例(17.2%)，实性结节91例(43.5%)，其他结节7例(3.3%)。手术方式包括楔形切除131例(71.2%)，节段切除51例(27.7%)，其他2例(1.1%)。178个病灶被成功切除(87.8%[95%可信区间，82.4-91.9%])，虚拟辅助肺标记物成功地帮助190个病变识别(93.6%[95%可信区间，89.3-96.5%])。多因素分析显示，影响手术成功率的最显著因素是手术切缘的深度(P=.0072)。结论：虽然手术切除率未达到初步目标，但虚拟辅助肺标测具有合理的疗效。所需切缘的深度是导致切除失败的最重要因素。
Objective: Virtual-assisted lung mapping is a preoperative bronchoscopic multi-spot dye-marking technique. This study aimed to examine the efficacy of virtual-assisted lung mapping for obtaining sufficient surgical margins in sublobar lung resection.Methods: The multicenter, prospective, single-arm study was conducted from September 2016 to July 2017 in 19 registered centers. Patients who required sublobar lung resection and careful determination of resection margins underwent virtual-assisted lung mapping followed by thoracoscopic surgery. Successful resection was defined as resection of the lesion with margins greater than the lesion diameter or 2 cm using the preoperatively planned resection without additional resection. We defined the primary goal of the study as achieving successful resection in 95% of lesions.Results: The resection of 203 lesions (average diameter, 9.6 +/- 5.3 mm) was intended in 153 patients. The lesions included pure and mixed ground-glass nodules (75 [35.9%] and 36 [17.2%], respectively), solid nodules (91 [43.5%]), and others (7 [3.3%]). Surgical procedures included wedge resection (131, 71.2%), segmentectomy (51, 27.7%), and others (2, 1.1%). Successful resection was achieved in 178 lesions (87.8% [95% confidence interval, 82.4-91.9%]), and virtual-assisted lung mapping markings successfully aided in the identification of 190 lesions (93.6% [95% confidence interval, 89.3-96.5%]). Multivariable analysis showed that the most significant factor affecting resection success was the depth of the necessary resection margin (P = .0072).Conclusions: This study showed that virtual-assisted lung mapping has reasonable efficacy, although the successful resection rate did not reach the primary goal. The depth of the required margin was the most significant factor leading to resection failure.