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

OBJECTIVES: 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.

METHODS: 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 CT-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.

RESULTS: 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 segmentecomy, 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) min vs (142.1 ± 38.9) min], estimated blood loss [(111.3 ± 74.0) mL vs (106.0 ± 63.8) mL], duration of chest tube duration [(5.1 ± 3.0) days vs (5.0 ± 3.5) days], and total drainage volume [(872.3 ± 643.1) mL vs (826.7 ± 806.0) mL], with a p value >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.

CONCLUSIONS: 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.

CLINICAL TRIAL REGISTRATION: The trial was registered under Chinese Clinical Trial Registry (ChiCTR). Identifier: ChiCTR1800018293. https://www.chictr.org.cn/showproj.html?proj=29345.