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J Chest Surg

Published online April 23, 2024

Copyright © Journal of Chest Surgery.

Comparative Study of Indocyanine Green Intravenous Injection and the Inflation-Deflation Method for Assessing Resection Margins in Segmentectomy for Lung Cancer: A Single-Center Retrospective Study

Seon Yong Bae , M.D.1,2, Taeyoung Yun , M.D.1,2, Ji Hyeon Park , M.D.1,2, Bubse Na , M.D.1,2, Kwon Joong Na , M.D.1,2,3, Samina Park , M.D.1,2, Hyun Joo Lee , M.D., Ph.D.1,2, In Kyu Park , M.D., Ph.D.1,2, Chang Hyun Kang , M.D., Ph.D.1,2, Young Tae Kim , M.D., Ph.D.1,2,3

1Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital; 2Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine; 3Seoul National University Cancer Research Institute, Seoul, Korea

Correspondence to:Kwon Joong Na
Tel 82-2-2072-1423
Fax 82-2-764-3665
E-mail npeter1@snu.ac.kr
ORCID
https://orcid.org/0000-0003-4158-9790

Received: January 16, 2024; Revised: February 11, 2024; Accepted: February 29, 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: The inflation-deflation (ID) method has long been the standard for intraoperative margin assessment in segmentectomy. However, with advancements in vision technology, the use of near-infrared mapping with indocyanine green (ICG) has become increasingly common. This study was conducted to compare the perioperative outcomes and resection margins achieved using these methods.
Methods: This retrospective study included patients who underwent direct segmentectomy for clinical stage I lung cancer between January 2018 and September 2022. We compared perioperative factors, including bronchial and parenchymal resection margins, according to the margin assessment method and the type of segmentectomy performed. Since the ICG approach was adopted in April 2021, we also examined a recent subgroup of patients treated from then onward.
Results: A total of 319 segmentectomies were performed. ID and ICG were utilized for 261 (81.8%) and 58 (18.2%) patients, respectively. Following April 2021, 61 patients (51.3%) were treated with ID, while 58 (48.7%) received ICG. We observed no significant difference in resection margins between ID and ICG for bronchial (2.7 cm vs. 2.3 cm, p=0.07) or parenchymal (2.5 cm vs. 2.3 cm, p=0.46) margins. Additionally, the length of hospitalization and the complication rate were comparable between groups. Analysis of the recent subgroup confirmed these findings, showing no significant differences in resection margins (bronchial: 2.6 cm vs. 2.3 cm, p=0.25; parenchymal: 2.4 cm vs. 2.3 cm, p=0.75), length of hospitalization, or complication rate.
Conclusion: The perioperative outcomes and resection margins achieved using ID and ICG were comparable, suggesting that both methods can safely guide segmentectomy procedures.

Keywords: Lung neoplasms, Segmentectomy, Resection margin

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J Chest Surg

Published online April 23, 2024

Copyright © Journal of Chest Surgery.

Comparative Study of Indocyanine Green Intravenous Injection and the Inflation-Deflation Method for Assessing Resection Margins in Segmentectomy for Lung Cancer: A Single-Center Retrospective Study

Seon Yong Bae , M.D.1,2, Taeyoung Yun , M.D.1,2, Ji Hyeon Park , M.D.1,2, Bubse Na , M.D.1,2, Kwon Joong Na , M.D.1,2,3, Samina Park , M.D.1,2, Hyun Joo Lee , M.D., Ph.D.1,2, In Kyu Park , M.D., Ph.D.1,2, Chang Hyun Kang , M.D., Ph.D.1,2, Young Tae Kim , M.D., Ph.D.1,2,3

1Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital; 2Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine; 3Seoul National University Cancer Research Institute, Seoul, Korea

Correspondence to:Kwon Joong Na
Tel 82-2-2072-1423
Fax 82-2-764-3665
E-mail npeter1@snu.ac.kr
ORCID
https://orcid.org/0000-0003-4158-9790

Received: January 16, 2024; Revised: February 11, 2024; Accepted: February 29, 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: The inflation-deflation (ID) method has long been the standard for intraoperative margin assessment in segmentectomy. However, with advancements in vision technology, the use of near-infrared mapping with indocyanine green (ICG) has become increasingly common. This study was conducted to compare the perioperative outcomes and resection margins achieved using these methods.
Methods: This retrospective study included patients who underwent direct segmentectomy for clinical stage I lung cancer between January 2018 and September 2022. We compared perioperative factors, including bronchial and parenchymal resection margins, according to the margin assessment method and the type of segmentectomy performed. Since the ICG approach was adopted in April 2021, we also examined a recent subgroup of patients treated from then onward.
Results: A total of 319 segmentectomies were performed. ID and ICG were utilized for 261 (81.8%) and 58 (18.2%) patients, respectively. Following April 2021, 61 patients (51.3%) were treated with ID, while 58 (48.7%) received ICG. We observed no significant difference in resection margins between ID and ICG for bronchial (2.7 cm vs. 2.3 cm, p=0.07) or parenchymal (2.5 cm vs. 2.3 cm, p=0.46) margins. Additionally, the length of hospitalization and the complication rate were comparable between groups. Analysis of the recent subgroup confirmed these findings, showing no significant differences in resection margins (bronchial: 2.6 cm vs. 2.3 cm, p=0.25; parenchymal: 2.4 cm vs. 2.3 cm, p=0.75), length of hospitalization, or complication rate.
Conclusion: The perioperative outcomes and resection margins achieved using ID and ICG were comparable, suggesting that both methods can safely guide segmentectomy procedures.

Keywords: Lung neoplasms, Segmentectomy, Resection margin

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