Noninvasive 3D-CT simulation versus glue injection to localize small pulmonary nodules prior to anatomical segmentectomy: a randomized controlled trial.

Abstract

This study aimed to investigate whether adding glue injection to three-dimensional computed tomography bronchography and angiography (3D-CTBA) has extra benefits to facilitate anatomical segmentectomy for pulmonary nodules. We conducted a randomized controlled trial. The patients undergoing thoracoscopic segmentectomy assisted with 3D-CTBA simulation were enrolled. Then, they were divided into the 3D-CTBA group and the glue-labelling group who received additional computed tomography-guided percutaneous glue (2-octyl cyanoacrylate) injection to label the nodules. The primary outcome was the resection rate of the nodules, and the secondary measures included the operation time, complications and thorax drainage. A total of 173 patients were randomized into the 3D-CTBA group (89 patients) and glue-labelling group (84 patients) between January 2018 and March 2019. Before the segmentectomy, the patients using glue labelling recorded 5 (6.0%) cases of pneumothorax, 2 (2.4%) cases of haemothorax and 1 (1.2%) case of severe chest pain. All the surgical procedure was performed fluently and safely. The resection rate of the nodules was 100% in both groups. Furthermore, these patients demonstrated similar operation time [(141.5 ± 41.9) vs (142.1 ± 38.9) min], estimated blood loss [(111.3 ± 74.0) vs (106.0 ± 63.8) ml], duration of chest tube duration [(5.1 ± 3.0) vs (5.0 ± 3.5) days] and total drainage volume [(872.3 ± 643.1) vs (826.7 ± 806.0) ml], with a P-value of >0.05 respectively. In addition, 6 (7.1%) patients in the glue-labelling group and 6 (6.7%) patients in the 3D-CTBA group reported air leakage (>5 days) and chylothorax. Noninvasive 3D-CTBA alone is probably sufficient to facilitate anatomical segmentectomy. The additional invasive glue labelling could be avoided in selected patients who undergo intentional segmentectomy. The trial was registered under the Chinese Clinical Trial Registry (ChiCTR). Identifier: ChiCTR1800018293, https://www.chictr.org.cn/showproj.html?proj=29345.