Puncture frequency predicts pneumothorax in preoperative computed tomography‐guided lung nodule localization for video‐assisted thoracoscopic surgery. Issue 13 (25th May 2022)

• Record Type: Journal Article
• Authors: Huang, Jing‐Yang; Tsai, Stella Chin‐Shaw; Wu, Tzu‐Chin; Lin, Frank Cheau‐Feng
• Is Part Of: Thoracic cancer. Volume 13:Issue 13(2022)
• Page Start: 1925
• Page End: 1932
• Publication Date: 2022-05-25
• Subjects: iatrogenic pneumothorax -- preoperative CT guided localization -- pulmonary nodule -- video‐assisted thoracoscopic surgery; Chest -- Cancer -- Periodicals; Chest -- Cancer -- Treatment -- Periodicals; Chest -- Surgery -- Periodicals; 616.99494005
• DOI: 10.1111/1759-7714.14457
• Languages: English
• ISSNs: 1759-7706

Abstract

Abstract: Background: Iatrogenic pneumothorax is the most frequent complication in preoperative CT‐guided localization (POCTGL) of lung nodules. We aimed to determine the predictive factors of iatrogenic pneumothorax. Methods: We retrospectively analyzed data of consecutive POCTGL procedures in patients who received video‐assisted thoracoscopic surgery (VATS) at our hospital between May 2015 and October 2019. All of our patients utilized laser angle guide assembly to aid in the localization procedures. Results: In 610 consecutive POCTGL procedures, 40 (6.6%) patients developed iatrogenic pneumothorax, and complications occurred in 8.5%. Univariate analyses revealed that puncture frequency, male gender, puncture depth, left decubitus position, and nodule near fissure were factors associated with pneumothorax, while multivariate analysis showed that only male gender (odds ratio 3.58, p = 0.012) and puncture frequency (odds ratio 2.39/time, p = 0.0004) determined development of pneumothorax. Further collective analysis on puncture frequency revealed that tumor in a difficult zone (1.33 ± 0.71 vs. 1.19 ± 0.45, p = 0.002), especially adjacent to the mediastinum (1.41 ± 0.75 vs. 1.21 ± 0.52, p = 0.002), angle difference of plan‐to‐practice (r = 0.209, p = < 0.001), depth to skin (r = 0.152, p < 0.001), and depth to pleura (r = 0.164, p < 0.001) were factors related to increased puncture frequency in univariate analyses. Only angle difference of plan‐to‐practice was associated in multivariate analysis (odds ratio: 1.158, p = 0.008). Conclusions: Puncture frequency was the key factor in the development of iatrogenic pneumothorax from POCTGL. Other associated factors, especially angle difference, may have affected the puncture frequency and subsequently have some influence on the incidence of iatrogenic pneumothorax. Abstract : Iatrogenic pneumothorax is the most frequent complication in preoperative CT‐guided localization (POCTGL) of lung nodules. We retrospectively analyzed data of 610 consecutive POCTGL procedures, in which 40 (6.6%) patients developed iatrogenic pneumothorax. Puncture frequency was the key factor in iatrogenic pneumothorax from preoperative lung nodule localization. In performing preoperative lung nodule localization, every effort should be attempted to keep puncture frequency to a minimum.