title: Management of Intersegmental Plane on Pulmonary Segmentectomy Concerning Postoperative Complications.
abstract: BACKGROUND
  For primary lung cancer, anatomic pulmonary segmentectomy may have a functional advantage over lobectomy; however, persistent air leak or delayed pneumothorax after segmentectomy is prevalent and increases surgical morbidity. To prevent pulmonary complications after pulmonary segmentectomy, we used 2 methods for the involved intersegmental plane: coverage using polyglycolic acid mesh and fibrin glue (mesh cover) or closing it by suturing the pleural edge (pleural suture). We aimed to compare postoperative pulmonary function and complications between the 2 groups.
  
  
  METHODS
  A total of 133 patients who underwent pulmonary segmentectomy for stage IA non-small cell lung cancer were analyzed retrospectively. A pulmonary function test, including vital capacity and forced expiratory volume in 1 second, was performed preoperatively and at 1 and 6 months postoperatively. Propensity score analysis generated 2 matched pairs of 46 patients in the pleural suture and mesh cover groups.
  
  
  RESULTS
  In each group, there was no significant difference in the recovery rate of vital capacity and forced expiratory volume in 1 second at 1 and 6 months postoperatively. Compared with the pleural suture group, the mesh cover group had higher incidence of prolonged air leak (8.7% versus 0%; p = 0.042), delayed pneumothorax (10.9% versus 2.2%; p = 0.051). On logistic regression analysis, management of intersegmental plane by either mesh cover or pleural suture was the only independent factor related to pulmonary complications (prolonged air leak or delayed pneumothorax) after pulmonary segmentectomy (odds ratio: 5.26, p = 0.047; odds ratio: 13.39, p = 0.018, respectively).
  
  
  CONCLUSIONS
  Pleural suturing of the involved intersegmental plane during pulmonary segmentectomy appeared to be an acceptable method to reduce postoperative pulmonary complications.
authors.affiliation: Department of Thoracic Surgery, Akita University School of Medicine, Akita, Japan. Electronic address: hsaito@doc.med.akita-u.ac.jp.
authors.forename: Hajime
authors.initials: H
authors.lastname: Saito
authors.affiliation: Department of Thoracic Surgery, Akita University School of Medicine, Akita, Japan.
authors.forename: Hayato
authors.initials: H
authors.lastname: Konno
authors.affiliation: Department of Thoracic Surgery, Akita University School of Medicine, Akita, Japan.
authors.forename: Maiko
authors.initials: M
authors.lastname: Atari
authors.affiliation: Department of Thoracic Surgery, Akita University School of Medicine, Akita, Japan.
authors.forename: Nobuyasu
authors.initials: N
authors.lastname: Kurihara
authors.affiliation: Department of Thoracic Surgery, Akita University School of Medicine, Akita, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Fujishima
authors.affiliation: Department of Thoracic Surgery, Akita University School of Medicine, Akita, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Sato
authors.affiliation: Department of Thoracic Surgery, Akita University School of Medicine, Akita, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Motoyama
authors.affiliation: Department of Thoracic Surgery, Akita University School of Medicine, Akita, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Minamiya
mesh_terms: D000368:Aged; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008168:Lung / Q000503:physiopathology* / Q000601:surgery; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010994:Pleura / Q000601:surgery*; D011013:Pneumonectomy / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000503:physiopathology; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013526:Surgical Mesh; D013537:Sutures; D014797:Vital Capacity