Long-Term Outcomes of Indocyanine Green Versus Inflation-Deflation for Intersegmental Plane Identification in Segmentectomy for Early-Stage Lung Cancer

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OBJECTIVES: This study aimed to evaluate whether the method of intersegmental plane (ISP) identification-indocyanine green (ICG) fluorescence vs the conventional inflation-deflation (ID) technique-affects resection margin adequacy, oncologic outcomes, or postoperative pulmonary function after anatomical segmentectomy for early-stage non-small-cell lung cancer (NSCLC). METHODS: We retrospectively analysed 410 patients who underwent segmentectomy for clinical N0M0 NSCLC between January 2018 and December 2023. The ISP was identified using the ID and ICG methods in 286 and 124 patients, respectively. Perioperative, pathologic, and survival outcomes were compared before and after inverse probability of treatment weighting (IPTW). RESULTS: Operative time and hospital stay were slightly shorter in the ICG than in the ID group (108.0 vs 115.0 min, P = .031; 4.0 vs 5.0 days, P = .003), whereas postoperative complication rates and pulmonary function changes were comparable. Central resection margins were longer in the ID group (2.5 vs 2.0 cm, P = .014), whereas lateral margin distances did not differ significantly. Recurrence-free and overall survival were similar between the 2 groups (log-rank P = .97 and P = .18). In IPTW-adjusted multivariable Cox analysis, the ISP identification method was not associated with recurrence or survival. CONCLUSIONS: The ISP identification method was not associated with differences in functional or oncologic outcomes after anatomical segmentectomy. These findings suggest that the choice of technique may be guided by surgeon preference and technical considerations.

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