A prospective single-arm study on surgical treatment of pulmonary nodules located beneath the interlobar pleura and adjacent to the pulmonary hilum

Background and purpose: Accurately locating pulmonary nodules is the key to the success of thoracoscopic surgery. This study aimed to investigate the strategy and evaluate the feasibility, safety, and clinical value of thoracoscopic surgical treatment for pulmonary nodules located beneath the interlobar pleura and close to the pulmonary hilum. Methods: The patients who underwent pulmonary nodule surgery at Liaocheng Tumor Hospital from May 2023 to November 2024 were enrolled, and the patients who did not meet the inclusion criteria were excluded. This study was approved by the Ethics Committee of Liaocheng Tumor Hospital (EC-20240112-1020) and informed consent was obtained from the patients. The research was designed as a prospective single-arm study. The patients were treated with wedge resection, which was performed following CT-guided localization, where the location needle was inserted through the interlobar pleura. The feasibility of the procedure was evaluated by analyzing the success rate of preoperative localization and perioperative complications. Results: A total of 28 patients who met the inclusion criteria were included in this study. There were 5 male and 23 female patients with an average age of (56.0±8.5) years (range 38-69 years). In all, 28 patients with 28 nodules underwent thoracoscopic wedge resection, and the preoperative CT-guided localization was successfully performed in all patients, without urgent complications. The mean operation time of thoracoscopic surgery was (15.6±4.0) min, intraoperative bleeding was (20.9±14.3) mL, and postoperative drainage was (214.3±62.2) mL. No cases of postoperative air leaks or conversion to thoracotomy were observed. The average length of hospital stay was (5.4±0.9) days. The postoperative histological diagnosis revealed 3 benign lesions (pulmonary fibrosis in 2 cases, atypical adenomatous hyperplasia in 1 case) and 25 malignant lesions (adenocarcinoma in situ in 5 cases, minimally invasive adenocarcinoma in 16 cases, and invasive adenocarcinoma in 4 cases). Conclusion: Thoracoscopic wedge resection following CT-guided nodule localization through the interlobar pleura is a feasible approach for nodules located beneath the interlobar pleura and close to the pulmonary hilum. The method ensures precise tumor localization, adequate margin, and minimal loss of normal lung tissue, with a low incidence of postoperative complication, which has important guiding significance for the surgical treatment of pulmonary nodules in such special locations.