• Masaaki Sato, Masashi Kobayashi, Fumitsugu Kojima, Fumihiro Tanaka, Masahiro Yanagiya, Shinji Kosaka, Ryuta Fukai, and Jun Nakajima.
• Department of Thoracic Surgery, The University of Tokyo, Tokyo, Japan. Electronic address: satom-sur@h.u-tokyo.ac.jp.
• J. Thorac. Cardiovasc. Surg. 2018 Oct 1; 156 (4): 1691-1701.e5.

ObjectiveVirtual-assisted lung mapping is a preoperative bronchoscopic multi-spot dye-marking technique. This study aimed to examine the efficacy of virtual-assisted lung mapping for obtaining sufficient surgical margins in sublobar lung resection.MethodsThe multicenter, prospective, single-arm study was conducted from September 2016 to July 2017 in 19 registered centers. Patients who required sublobar lung resection and careful determination of resection margins underwent virtual-assisted lung mapping followed by thoracoscopic surgery. Successful resection was defined as resection of the lesion with margins greater than the lesion diameter or 2 cm using the preoperatively planned resection without additional resection. We defined the primary goal of the study as achieving successful resection in 95% of lesions.ResultsThe resection of 203 lesions (average diameter, 9.6 ± 5.3 mm) was intended in 153 patients. The lesions included pure and mixed ground-glass nodules (75 [35.9%] and 36 [17.2%], respectively), solid nodules (91 [43.5%]), and others (7 [3.3%]). Surgical procedures included wedge resection (131, 71.2%), segmentectomy (51, 27.7%), and others (2, 1.1%). Successful resection was achieved in 178 lesions (87.8% [95% confidence interval, 82.4-91.9%]), and virtual-assisted lung mapping markings successfully aided in the identification of 190 lesions (93.6% [95% confidence interval, 89.3-96.5%]). Multivariable analysis showed that the most significant factor affecting resection success was the depth of the necessary resection margin (P = .0072).ConclusionsThis study showed that virtual-assisted lung mapping has reasonable efficacy, although the successful resection rate did not reach the primary goal. The depth of the required margin was the most significant factor leading to resection failure.Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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