Clinical trial NCT03227380: Morphologic Study of the Intersegmental Plane After Fully Thoracoscopic Segmentectomy
Official title: Morphologic Study of the Intersegmental Plane After Fully Thoracoscopic Segmentectomy
Study type: INTERVENTIONAL
Overall status: UNKNOWN
Phase: NA
Conditions: Video-assisted Thoracoscopic Surgery (VATS)
Segmentectomy
Lead sponsor: Institut Mutualiste Montsouris
Sponsor class: OTHER
First posted: 2017-07-24
Enrollment: 40
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Intervention model description: patients undergo anatomic segmentectomy by video-assisted thoracoscopic surgery (VATS)
Primary purpose: OTHER

Brief summary: The objective of this study is to determine whether stapling adversely affects the pulmonary parenchyma and the vascularisation of the adjacent segments. The aim of our work is to explore by thoracic densitometry with contrast the spared segments after stapling of the intersegmental plan following a thoracoscopic segmentectomy, 3 or 6 months post-surgery. the investigator will assess venous drainage and the arterial vascularisation of the remaining segments, possible modifications of the adjacent parenchyma and whether there is a defect of pleuro-pulmonary adhesion (residual pneumothorax).

Detailed description: Scheduled anatomical segmentectomies are increasingly popular, due to the development of minimally invasive techniques, the increased incidence of early-stage tumours, and the possibility of caring for patients with compromised health and/or limited respiratory function without compromising the oncological outcome, compared to current alternatives such as stereotactic ablative radiotherapy (1).

One of the challenges in the development of the thoracoscopic segmentectomy technique we have published (2-5) is the orientation (6-7) and the division of the intersegmental plane, by contrast to segmentectomy by thoracotomy where this is helped by palpation and the manual traction which can be used on the segment, along the intersegmental vein. The most commonly used technique to separate two adjacent segments remains stapling, despite its high cost and sometimes giving a less anatomical section, with a risk to encroach on the intersegmental vein. Moreover, there can be a partial plicator of the spared segment(s) which could in theory make them less functional.

We have however shown that the postoperative morbidity and mortality rates were much lower than that of patients who had a thoracotomy, dropping from 42% for thoracotomies to 16% for thoracoscopies, the surgical approach being an independent predictive factor for postoperative complications (8).

Eligibility criteria: Inclusion Criteria:

* Enrolment in the study will be offered to all patients having undergone a programmed scheduled video-assisted thoracoscopic segmentectomy, whatever the aetiology.
* Men or women aged 18 years or greater
* Absence of severe hepatic insufficiency
* signed and dated informed consent
* candidate for segmentectomy
* Registration in a national healthcare system.
* Women of child-bearing age using effective oral or barrier contraception

Exclusion Criteria:

* Proven intolerance to iodinated contrast agents
* Know allergy or non-controlled asthma - pregnancy
* Severe hepatic insufficiency (creatinine clearance \< 30ml/min, by Cockroft's method)
* Pregnant or breastfeeding women
* Patients under trusteeship or curators
* Diabetic patients or patients receiving oral antidiabetic medication

Primary outcomes:
measure: The measure of the remaining segments after stapling the intersegmental plane by injected CT scan
timeFrame: 3 or 6 months after surgery
Secondary outcomes:
Other outcomes:
Locations:
city: Paris
country: France
facility: Institut Mutualiste montsouris
city: Paris
country: France
facility: Institut mutualiste montsouris
Study officials:
References: