Prevalence of incomplete interlobar fissures of the lung

Abstract

Background. Some patients benefit from accurate integrity assessment of pulmonary fissures. There are a number of methods for the assessment of incomplete interlobar fissures: imaging techniques, endobronchial methods measuring collateral air flow, a perioperative view, and autopsies used in research into pulmonary anatomy. Methods and Results. We performed a computerized advanced search for primary evidence in the PubMed (Public/ Publisher MEDLINE) and Google Scholar electronic databases using the following terms: incomplete and fissure. The search was not restricted to the English literature, nor limited by publication time. The bibliographic search was then extended to the "Related Articles" links and to the list of literature references of each article. Conclusion. Publications have consistently shown that interlobar fissures exhibit high variability and that preoperative or at least detailed perioperative assessment can influence the effect of treatment.

Effects of degree of pulmonary fissure completeness on major in-hospital outcomes after video-assisted thoracoscopic lung cancer lobectomy: a retrospective-cohort study

“…Imaging techniques, especially high-resolution computerized tomography (CT) and multidetector CT, with their 3-D reconstructions, have mostly been used to assess the integrity of interlobar fissures preoperatively, although these computerized methods still need to be validated, especially in patients with heterogeneously diseased lungs. 26 , 27 By visual inspection of thin-section CT images, an interlobar fissure can be seen as a thin line that separates neighboring lobes, while the line is generally disconnected by vessels or lung parenchyma in cases of incompleteness. Perioperative mapping is performed only on patients with serious pulmonary diseases, although this method depends on the surgeon’s area of interest and expertise.…”

“…Perioperative mapping is performed only on patients with serious pulmonary diseases, although this method depends on the surgeon’s area of interest and expertise. 26 An autopsy can also help to distinguish adjacent lobes, but with the obvious drawback that it can only be performed on eviscerated lungs postoperatively.…”

Effects of pulmonary fissure completeness on major outcomes in children after video-assisted thoracoscopic congenital lung malformation lobectomy

“…There are several possibilities for assessing fissures: computerized tomography (CT) scans; endobronchial systems assessing collateral flow and perioperative methods. A meta-analysis [ 24 ] of 31 related articles showed: The position of the fissures exhibits high variability, sometimes a fissure is missing completely (usually the horizontal one), the prevalence of incomplete fissures ranged from 19.2% to 77% (mean 48.7), 17.4% to 87% (mean 55.4), and 48.3% to 89% (mean 69.8) for left oblique, right oblique, and horizontal fissures, respectively. In our data, the location of the lesion in group A was significantly more frequent in the right upper lobe (33.3% vs 8.7%), this is similar to the results of other literatures’.…”

Authors’ response: it’s time to consider integrating the degree of pulmonary fissure completeness into a morbidity risk scoring system for video-assisted thoracoscopic pulmonary resections

“…However, despite encouraging radiological findings, such CT methods still need to be validated, especially for heterogeneous lung diseases, when anticipation of PFC is suboptimal and often under dispute between the radiologists and the surgeons (10,11). PFC evaluation under direct visualization during the surgery may now be more feasible and widely accepted among thoracic surgeons, although this method really depends on the surgeon's area of interest and expertise (12). Therefore, we highly recommend the FDS-FSA scoring system proposed by Dr. Lee with his colleagues as a superior alternative to determine the degree of PFC in VATS pulmonary resections (9).…”