Polyglycolic Acid Reinforcement for Prevention of Postoperative Air Leak after Pulmonary Resection for Pulmonary Malignancy: A Systematic Review and Meta-Analysis

Background: Postoperative air leak, including prolonged air leak (PAL), remains a common complication after pulmonary resection for pulmonary malignancy. Polyglycolic acid (PGA)-based reinforcement may improve staple-line sealing; however, evidence of its effectiveness remains limited, and PGA application methods vary across studies. This study aimed to evaluate whether PGA-based reinforcement reduces postoperative air leak after pulmonary resection for pulmonary malignancy. Methods: This systematic review and meta-analysis was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. Five databases were searched through April 2026. Studies comparing PGA-based reinforcement with conventional stapling in patients undergoing pulmonary resection for pulmonary malignancy were eligible for inclusion. The primary outcome was postoperative air leak. Results: Five observational cohort studies involving 1,896 patients were included. PGA-based reinforcement was associated with lower odds of postoperative air leak (odds ratio [OR], 0.22; 95% confidence interval [CI], 0.11-0.43; p<0.0001) and PAL (OR, 0.28; 95% CI, 0.11-0.69; p=0.005). No significant differences were observed in operative time, blood loss, chest tube duration, or length of hospital stay (all p>0.05). The certainty of the evidence was very low. Conclusion: PGA-based reinforcement may reduce postoperative air leak and PAL after pulmonary resection for pulmonary malignancy; however, further high-quality randomized controlled trials are needed (International Prospective Register of Systematic Reviews, registration number: CRD420261372690).