Efficacy and safety of Innoseal for air leak after pulmonary resection: a case-control study Francesco Petrella, MD, a, * Alessandro Borri, MD, a Daniela Brambilla, PhD, a Giorgio Calanca, PhD, b Nicola Vezzani, PhD, b Antonio Colantoni, PhD, c Adolfo Gasparetto, MD, c and Lorenzo Spaggiari, MD a,d a Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy b Enable Innovations s.r.l, Modena, Italy c Nextrasearch s.a.s, Padua, Italy d Department of Oncology and Hematology-OncologydDIPO, University of Milan, Milan, Italy article info Article history: Received 19 March 2016 Received in revised form 21 June 2016 Accepted 23 June 2016 Available online 1 July 2016 Keywords: Lung resection Prolonged air leak Cyanoacrylate abstract Background: Prolonged air leak is one of the most common complications after lung surgery and the cause of prolonged hospital stay frequently associated with major postoperative morbidity and thus responsible for even higher hospital costs. This case-control study was designed to test the sealing efficacy and safety of Enable-Innoseal TP4 in patients under- going pulmonary resection for lung cancer. Methods: This was a case-control trial enrolling patients with primary or single site meta- static lung cancer scheduled for elective anatomic or nonanatomic pulmonary resection presenting intraoperative grade 1 or 2 air leak at water submersion test; the study group population was then matched 1:1 according to surgical procedure, male/female ratio, preoperative FEV1, and age. Results: In the study population, 21 patients (70.0%) presented intraoperative grade 1 air leak and 9 patients grade 2 (30.0%) air leak; after comparison with the control group, we observed a significant shorter time for chest drain removal in the study population (P ¼ 0.0050), whereas no difference was registered in terms of number of days needing for discharge (P ¼ 0.0762). Conclusions: Enable-Innoseal TP4 was effective in treating limited intraoperative air leaks after pulmonary resection and preventing prolonged postoperative air leaks in patients receiving either anatomic or nonanatomic lung resections. Further randomized double- arm studies are required to confirm the efficacy of Enable-Innoseal TP4 demonstrated by this pilot study. ª 2016 Elsevier Inc. All rights reserved. Introduction Prolonged air leak (PAL) is one of the most common compli- cations after lung surgery. 1 PAL is defined as air coming out of the remaining lung tissue until the fourth, fifth, or seventh postoperative day, according to different classifications. 2-5 PAL alone is a cause of prolonged hospital stay and is frequently associated with major postoperative morbidity (lobar collapse, nosocomial pneumonia, and pleural empy- ema) thus being responsible for even higher hospital costs. 3 * Corresponding author. Department of Thoracic Surgery, European Institute of Oncology, Via Ripamonti, 435, Milan 20141, Italy. Tel.: þ39 0257489362; fax: þ39 0294379218. E-mail address: francesco.petrella@ieo.it (F. Petrella). Available online at www.sciencedirect.com ScienceDirect journal homepage: www.JournalofSurgicalResearch.com journal of surgical research  november 2016 (206) 22 e26 0022-4804/$ e see front matter ª 2016 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jss.2016.06.066