# Does the Fissure Last Technique Really Reduce Postoperative Airleak After Lung Resection? Results From a Prospective Randomized Controlled Trial

## TL;DR

A study tested if the fissure last technique reduces airleaks after lung surgery but found no significant benefit.

## Contribution

This paper provides clinical evidence from a randomized trial on the efficacy of the fissure last technique in reducing postoperative airleaks.

## Key findings

- The fissure last technique showed a 5% lower airleak rate on day 2 compared to the fissure first technique.
- No significant benefit was observed in patients with expected higher airleak rates.
- The study found no improvement in prolonged airleak, chest drain duration, or hospital stay with the fissure last technique.

## Abstract

The fissure last (FL) technique described in 1998 has the goal of minimizing postoperative airleak leaving the stapling of the fissure as the last step. The aim of this study was the reduction in airleak may be already evident 48 hours after surgery.

The hypothesis of the study was that the routine of adopting the FL technique during lung resection for NSCLC active may reduce the number of patients presenting an airleak 48 hours after surgery assessed by a digital device. The study was designed as a prospective phase III single-centre 1:1 randomized trial, which compared the FL technique with the standard fissure first (FF) technique. Sample size was calculated assuming a 50% reduction of airleak at 48 hours in the FL group, and it was set at 150 cases according to previously published evidence.

Regarding the main end-point, air leaks on POD2 were 5% lower in the FL group as compared to the FF group (50% vs 55%, P .51) and that difference was maintained on POD 5 (26% vs 32%, P .42). In the subgroup of patients in which a higher rate of airleak was expected (Walker 3 and 4, n = 33), the adoption of the FL technique did not show a significant benefit in terms of prolonged airleak (PAL), chest drain duration and hospital stay.

Results from this study suggest that the FL strategy does not confer any benefit in terms of PAL, even in the context of an incomplete fissure. Clinical registration number: n 184/2020, 5/11/2020, EudraCT2020-004900-33

Prolonged airleak (PAL) often affects postoperative outcome after lung resection, delaying drain removal and hospital discharge.