ORIGINAL RESEARCH article
Front. Surg.
Sec. Thoracic Surgery
This article is part of the Research TopicAdvances in the Management of Postoperative Air Leak Following Pulmonary ResectionView all 4 articles
VENTILATION SPECT/CT-GUIDED AIR LEAK MANAGEMENT: IMPROVING PRECISION IN A LONG-STANDING SURGICAL CHALLENGE
Provisionally accepted
Marta Fuentes1,2,3
Maria Teresa Gomez Hernandez1,2,3*
Andrea Peñaherrera Cepeda1
Cristina Rivas1,2,3Jose Luis Aranda1,2,3Oscar Colmenares1,3Mario Manama1,3
Felipe Gómez-Caminero1,2Pilar Tamayo1,2
Marcelo Jimenez1,2,3- 1Hospital Universitario de Salamanca, Salamanca, Spain
- 2University of Salamanca, Salamanca, Spain
- 3Instituto de Investigacion Biomedica de Salamanca, Salamanca, Spain
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OBJECTIVES: Prolonged air leak (PAL) remains a significant surgical challenge after pulmonary resections and secondary spontaneous pneumothorax. Ventilation single-photon emission computed tomography combined with computed tomography (vSPECT/CT) has emerged as a promising tool for air leak localization. This study evaluates the impact of preoperative vSPECT/CT on surgical management of PAL. METHODS: This single-center study compared a prospectively enrolled vSPECT/CT cohort (February 2021–December 2025) with retrospective historical controls (January 2015–January 2021). Propensity score matching generated two matched groups: with and without vSPECT/CT. Primary outcome was vSPECT/CT accuracy in detecting air leaks; secondary outcomes included chest tube duration, persistent PAL, reoperation rates, and hospital stay. Wilcoxon signed-rank and McNemar tests were used for comparisons. RESULTS: A total of 122 patients were included (52 vSPECT/CT; 70 non-vSPECT/CT). vSPECT/CT showed a 95.3% concordance with intraoperative air leak localization. After matching, 86 patients (43 per group) were analyzed. The vSPECT/CT group had shorter chest tube duration (median 2 vs. 4 days; P = 0.01) and hospital stay (median 3 vs. 5 days; P = 0.036). Rates of persistent PAL and reoperation were similar between groups (P = 0.057 and P = 0.375, respectively). CONCLUSION: In this prospectively enrolled cohort, preoperative vSPECT/CT reliably localizes PAL, enabling focused surgical intervention and supporting more efficient postoperative recovery. Its use is associated with shorter chest tube duration and hospital stay, highlighting its value as a preoperative tool in the management of PAL.
Keywords: Prolonged air leak (PAL), Pulmonary resection, Secondary spontaneous pneumothorax (SSP), surgical outcome, ventilation SPECT/CT
Received: 03 Jan 2026; Accepted: 04 Feb 2026.
Copyright: © 2026 Fuentes, Gomez Hernandez, Peñaherrera Cepeda, Rivas, Aranda, Colmenares, Manama, Gómez-Caminero, Tamayo and Jimenez. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Maria Teresa Gomez Hernandez
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