The effectiveness and safety of computed tomography-guided hook-wire localization for secondary video-assisted thoracoscopic surgery: a retrospective study.

Background: Computed tomography (CT)-guided hook-wire localization is currently the most commonly used technique for preoperative localization of pulmonary nodules in clinical practice. With the increasing incidence of multiple primary lung cancers and the increasing occurrence of second primary lung cancers or local recurrences after lung cancer surgery, some patients need to undergo an ipsilateral or contralateral second pulmonary resection. In order to reduce the surgical difficulty of the second operation and accurately guide the surgical resection, preoperative localization of some nodules is necessary. This study retrospectively analyzed the CT-guided hook-wire localization information of patients undergoing a second ipsilateral or contralateral video-assisted thoracoscopic surgery (VATS), discussed the safety and effectiveness of hook-wire localization for ipsilateral and contralateral surgeries, and analyzed the risk factors for complications after localization.

Methods: This study retrospectively collected data from 113 patients with isolated solitary pulmonary nodules who underwent a second pulmonary resection and completed CT-guided hook-wire localization at The First Affiliated Hospital of Soochow University from January 2020 to June 2024. The patients were divided into contralateral surgery group and ipsilateral surgery group to compare clinical characteristics, localization time, incidence of complications, and other information between the two groups. Logistic regression analysis was used to identify the risk factors for complications associated with the localization methods in each group.

Results: Compared to the contralateral group, the ipsilateral group had a longer interval between the two surgeries, which was 28.0±9.3 months (P<0.001). The maximum diameter of nodules in the ipsilateral group was 10.8±1.7 mm, higher than that in the contralateral group (P<0.001). There were no statistical differences between the two groups in terms of localization time, number of CT scans, depth of the release position, and incidence of complications. In the contralateral group, 25 patients (30.5%) developed pneumothorax, while in the ipsilateral group, there were 2 cases (6.5%), showing a statistically significant difference (P=0.008). In the contralateral group, 3.7% patients developed hemopneumothorax, while the incidence in the ipsilateral group was as high as 16.1% (P=0.04). Localization time [odds ratio (OR) =1.306, P=0.006] and depth of the release position (OR =1.202, P<0.001) were independent risk factors for the overall occurrence of complications and pneumothorax, while thoracic adhesions (OR =4.115, P=0.03) was an independent risk factor for hemopneumothorax. History of localization (OR =0.109, P=0.02) was identified as a protective factor for pneumothorax.

Conclusions: CT-guided hook-wire localization can effectively complete the localization of isolated nodules on the ipsilateral or contralateral side in patients requiring a second pulmonary resection, with similar safety. In the future, it is more advisable to promote more precise and personalized localization methods for different patients in clinical practice.