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

The study reports the first prospective, randomized controlled trial comparing the fissure last (FL) technique with the traditional fissure first (FF) approach during anatomic lung resection for non-small cell lung cancer. The FL technique was designed to reduce postoperative air leaks by leaving the stapling of the fissure until the end of the operation. In this single-center, 1:1 trial encompassing 150 patients, the incidence of air leaks at postoperative day two was slightly lower in the FL group compared to the FF group (50 percent versus 55 percent), but this difference was not statistically significant. Additionally, there was no observed benefit in prolonged air leak rates, chest drain duration, or length of hospital stay. Subgroup analyses of patients prone to higher leak rates also failed to show meaningful advantages with the FL strategy. This article is important to the cardiothoracic surgery community because prolonged air leak remain one of the most common and morbid complications after lung resection. Surgeons continually seek technical refinements to reduce this risk. The trial findings suggest that the FL technique may not confer a clinically meaningful reduction in air leaks, thus informing operative strategy and helping teams in making evidence-based decisions about surgical techniques.