Performance of prolonged air leak scoring systems in patients undergoing video-assisted thoracoscopic surgery segmentectomy

Michel Gonzalez; Wolfram Karenovics; Benoît Bédat; Celine Forster; Marc-Olivier Sauvain; Frédéric Triponez; Michel Christodoulou; Thorsten Krueger; Jean Yannis Perentes

doi:10.1093/ejcts/ezac100

Performance of prolonged air leak scoring systems in patients undergoing video-assisted thoracoscopic surgery segmentectomy

Eur J Cardiothorac Surg. 2022 Aug 3;62(3):ezac100. doi: 10.1093/ejcts/ezac100.

Authors

Michel Gonzalez^{1

2}, Wolfram Karenovics^{3

2}, Benoît Bédat^{1

2}, Celine Forster^{1

2}, Marc-Olivier Sauvain^{4

2}, Frédéric Triponez^{3

2}, Michel Christodoulou^{5

2}, Thorsten Krueger^{1

2}, Jean Yannis Perentes^{1

2}

Affiliations

¹ University Hospital of Lausanne, Switzerland.
² Centre Universitaire Romand de Chirurgie Thoracique, Switzerland.
³ University Hospital of Geneva, Switzerland.
⁴ Hospital of Neuchâtel, Switzerland.
⁵ Hospital of Valais, Switzerland.

PMID: 35229873
DOI: 10.1093/ejcts/ezac100

Abstract

Objectives: We assessed the accuracy of 3 validated lobectomy scoring systems to predict prolonged air leak (PAL) in patients undergoing video-assisted thoracoscopic surgery (VATS) segmentectomy.

Methods: We reviewed all consecutive patients who had a VATS segmentectomy between January 2016 and October 2020. We determined PALs on postoperative day 5. These findings were correlated with the calculated Brunelli (gender, age, body mass index [BMI], forced expiratory volume in 1 s < 80 and pleural adhesion), Epithor (gender, location, dyspnoea score, BMI, type of resection and pleural adhesion) and European Society of Thoracic Surgeons (ESTS) (gender, BMI and forced expiratory volume in 1 s) scores of each patient.

Results: A total of 453 patients (mean age: 66.5 years, female/male sex ratio: 226/227) underwent a VATS segmentectomy for malignant (n = 400) and non-malignant (n = 53) disease. Postoperative cardiopulmonary complications and in-hospital mortality rates were 19.6% and 0.4%, respectively. Median chest tube drainage duration and hospital stay were 2 (interquartile range: 1-4) and 4 (interquartile range: 3-7) days, respectively. On day 5, the prevalence of PAL was 14.1%. The ESTS, Brunelli and Epithor scores for the treated population were, respectively, class A (6.8%), class B (3.2%), class C (10.8%) and class D (28.2%); very low and low (0%), moderate (5%), high (6.3%) and very high (21%); and class A (7%), class B (13.2%), class C (24%) and class D (27.8%). All scores correlated with PAL (p ≤ 0.001). The areas under the receiver operating characteristic (ROC) curve were 0.686, 0.680 and 0.644, respectively.

Conclusions: All 3 scoring systems were correlated with PAL > 5 days following the VATS segmentectomies. ESTS scores seem easier to introduce in clinical practice, but validation by a multicentre cohort is mandatory.

Keywords: VATS; air leak; lung cancer; scoring system; segmentectomy.

Publication types

Review

MeSH terms

Aged
Chest Tubes / adverse effects
Female
Humans
Lung Neoplasms* / complications
Lung Neoplasms* / surgery
Male
Mastectomy, Segmental / adverse effects
Pneumonectomy / adverse effects
Postoperative Complications / etiology
Thoracic Surgery, Video-Assisted* / adverse effects