Effect of virtual-assisted lung mapping in acquisition of surgical margins in sublobar lung resection

J Thorac Cardiovasc Surg. 2018 Oct;156(4):1691-1701.e5. doi: 10.1016/j.jtcvs.2018.05.122. Epub 2018 Jul 20.

Abstract

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.

Keywords: ground glass opacity; lung cancer; metastatic lung tumor; segmentectomy; wedge resection.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't
  • Webcast

MeSH terms

  • Adult
  • Aged
  • Bronchoscopy* / adverse effects
  • Coloring Agents / administration & dosage*
  • Coloring Agents / adverse effects
  • Female
  • Humans
  • Indigo Carmine / administration & dosage*
  • Indigo Carmine / adverse effects
  • Japan
  • Lung Neoplasms / diagnostic imaging
  • Lung Neoplasms / pathology
  • Lung Neoplasms / surgery*
  • Male
  • Margins of Excision*
  • Middle Aged
  • Multiple Pulmonary Nodules / diagnostic imaging
  • Multiple Pulmonary Nodules / pathology
  • Multiple Pulmonary Nodules / surgery*
  • Pneumonectomy / adverse effects
  • Pneumonectomy / methods*
  • Preoperative Care / adverse effects
  • Preoperative Care / methods*
  • Prospective Studies
  • Solitary Pulmonary Nodule / diagnostic imaging
  • Solitary Pulmonary Nodule / pathology
  • Solitary Pulmonary Nodule / surgery*
  • Thoracic Surgery, Video-Assisted* / adverse effects
  • Tomography, X-Ray Computed
  • Treatment Outcome

Substances

  • Coloring Agents
  • Indigo Carmine