Division of the intersegmental plane using electrocautery for segmentectomy in clinical stage I non-small cell lung cancer

Abstract

Background: Division of intersegmental planes is one of the important practical issues for segmentectomy to obtain feasible outcomes without relapse for clinical stage I non-small cell lung cancer. Almost all surgeons perform this procedure using a stapler. However, division of intersegmental planes for segmentectomy can also be performed by electrocautery. In this article, we demonstrate the merits and drawbacks of division of the intersegmental plane by electrocautery for segmentectomy. Methods: Of those 125 patients who underwent segmentectomy with clinical stage I primary lung cancer, we compared cautery cases (n=50) with stapler cases (n=75). The cautery group included 29 cases (58.0%) with partial use of a staple at the end of division. Results: Operative time was significantly longer in cautery cases (281±72 min) than stapler in cases (235±86 min; P=0.003). No difference in the duration of chest tube placement was evident between cautery (3.0±3.0 days) and stapler groups (2.8±1.7 days; P=0.613). However, delayed air leakage occurred significantly more frequently in cautery cases (14.0%) than in stapler cases (4.0%; P=0.048). Five-year overall survival (OS) in clinical stage I was 94.7% in cautery cases and 80.5% in stapler cases (log-rank P=0.047). Five-year disease-free survival (DFS) was 80.0% and 71.3%, respectively (log-rank P=0.075). Conclusions: The merits of cautery division include the ability to achieve meticulous division of the intersegmental plane and good preservation of the shape of residual segments. Conversely, the drawbacks include prolonged air leakage. Pleural suture or closure of residual segments may be useful to prevent delayed air leakage.

Electrocautery vs. Stapler in Comparing Safety for Segmentectomy of Lung Cancer: A Meta-Analysis

“…The surgery time was compared in four studies (12,(14)(15)(16) including 295 patients, and there was no significant difference between the two groups [MD = 18.07, 95% CI (−10.89, 47.04), P = 0.22]. The result was confirmative with high heterogeneity (I 2 = 77%, P = 0.004).…”

“…After a systematic review of the abstract in each publication, 297 studies were excluded, and the full text of the other 19 studies was reviewed. After evaluation, six studies were eventually enrolled (11)(12)(13)(14)(15)(16), including five retrospective observational studies and one RCT, with a total of 385 patients. The single-arm research studies and studies with no description of the comparison of surgical instruments were excluded.…”

“…The electrocautery group was taken as the experimental group, and the stapler group was regarded as the control group in our analysis. Five studies focusing on the incidence of air leaks presented that there were 23 in 156 patients (14.7%) suffering from air leaks in the electrocautery group and 7 in 180 patients (3.9%) suffering from air leaks in the stapler group (12)(13)(14)(15)(16). The incidence of postoperative air leaks in the electrocautery group was higher than that in the stapler group [OR: 3.91, 95% CI (1.64, 9.35), P = 0.002] (Figure 2).…”

“…Postoperative complications indicated the safety of the operation. Five studies revealed that 44 in 165 patients (26.7%) in the electrocautery group and 30 in 179 patients (16.8%) in the stapler group developed postoperative complications (11,12,(14)(15)(16). The incidence of complications in the electrocautery group was significantly higher than that in the stapler group [OR: 1.92, 95% CI (1.12, 3.28), P = 0.02] (Figure 3).…”

“…The result was confirmative with high heterogeneity (I 2 = 77%, P = 0.004). Four studies (12,13,15,16) including 288 patients focused on the duration of the drainage tube and showed no significant difference between the two groups [MD = 0.36, 95% CI (−0.27, 0.98), P = 0.26]. The details of the above and other outcomes are summarized in Table 3.…”