Postoperative airleak remains a major challenge after lung resection for non-small cell lung cancer. Consequently, many surgical experts often advocate for the fissure last technique to minimize parenchymal damage. However, high-quality clinical evidence comparing this method to the traditional fissure-first approach is limited. Therefore, Vaisitti F et al. conducted a phase III randomized controlled trial to provide clarity on this surgical debate.

Clinical Outcomes of the Fissure Last Technique

The study specifically examined the reduction of airleaks within 48 hours of surgery. To achieve this, researchers randomized 150 patients into two distinct groups. Surprisingly, the results showed no statistically significant difference between the techniques regarding the primary endpoint. Specifically, researchers observed similar airleak rates on postoperative day two in both groups. Furthermore, this trend continued through the fifth postoperative day without significant variation.

Incomplete Fissures and Recovery Metrics

In addition, the team analyzed patients with incomplete fissures as a specific subgroup. However, even these high-risk patients showed no significant clinical advantage from the specialized approach. Because of this, chest drain duration and hospital stay remained unchanged for those in the fissure-last group. Consequently, the findings suggest that the fissure last technique does not reliably prevent prolonged airleaks or enhance recovery speed.

Despite theoretical advantages, the strategy does not improve patient recovery outcomes compared to standard methods. Therefore, surgeons should continue to tailor their intraoperative approach to each individual case. In conclusion, while the approach is safe, it may not reduce the postoperative morbidity associated with lung resection.

Frequently Asked Questions

What is the fissure last technique in thoracic surgery?

The fissure last technique is a surgical method where hilar structures are dissected first, leaving the stapling of the lung fissure as the final step. This approach is intended to minimize airleaks by avoiding dissection through fused lung tissue.

Does this technique improve the length of hospital stay?

No, the recent RCT by Vaisitti F et al. found that using the fissure last technique did not significantly shorten hospital stays or the duration of chest drain placement, even in patients with incomplete fissures.

Disclaimer: This content is for informational and educational purposes only. It does not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition. Refer to the latest local and national guidelines for clinical practice.

References

1. Vaisitti F et al. Does the fissure last technique really reduce postoperative Airleak after lung resection? Results from a prospective randomised controlled trial. Interdiscip Cardiovasc Thorac Surg. 2026 Feb 13. doi: undefined. PMID: 41689184.


2. Bronstein ME et al. Management of air leaks post-surgical lung resection. Ann Transl Med. 2019;7(15):361.


3. Gómez-Caro A et al. The approach of fused fissures with fissureless technique decreases the incidence of persistent air leak after lobectomy. Eur J Cardiothorac Surg. 2007;31(2):203-208.