Related Experiment Video
Updated: Jun 6, 2025
Computer-Aided Three-Dimensional Visualization in the Treatment of Locally Advanced Thyroid Cancer
Published on: June 9, 2023
Oncologic outcomes of three-dimensional navigation-guided segmentectomy for early-stage non-small cell lung cancer
Wenzheng Xu1, Zhihua Li1, Xincen Cao1
1Department of Thoracic Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Background:
The outcomes of segmentectomy for small (≤2 cm) non-small cell lung cancer (NSCLC) have been well demonstrated. This study aimed to investigate whether segmentectomy could achieve comparable oncologic outcomes with lobectomy for >2-3 cm lung cancer.
Methods:
Patients who underwent segmentectomy or lobectomy for NSCLC >2-3 cm were retrospectively screened. Segmentectomy was performed under the guidance of three-dimensional computed tomographic bronchography and angiography (3D-CTBA). The log-rank test, Cox hazard proportional regression, and propensity score matching analyses were adopted for prognostic evaluation.
Results:
Among the 430 eligible patients, segmentectomy and lobectomy were performed for 103 and 327 patients, respectively. The median follow-up time was 60.2 months. No postoperative 90-day mortality occurred. There was no significant difference in postoperative complication (grade ≥2) between lobectomy and segmentectomy (19.3 % vs 16.5 %, P = 0.629). At 1 year or longer postoperatively, the difference in the median FEV1 and FVC reduction between the two groups was 2.3 % (P < 0.001) and 2.4 % (P = 0.028), respectively. The proportion of locoregional recurrence was 1.9 % after segmentectomy and 1.8 % after lobectomy. After propensity score matching, segmentectomy (n = 87) conferred a similar prognosis as lobectomy (5-year DFS: 89.1 % vs. 91.8 %; 5-year OS: 93.3 % vs. 93.0 %). Further subgroup analyses showed that segmentectomy achieved comparable long-term outcomes to lobectomy even for pure solid tumors (DFS: P = 0.850; OS: P = 0.720) or for tumors with a solid component size >2 cm (DFS: P = 0.640; OS: P = 0.800).
Conclusion:
The 3D-CTBA guided segmentectomy could achieve equivalent long-term outcomes to lobectomy for selected cT1N0M0 NSCLC with a tumor size >2 but ≤3 cm.
Insights
Segmentectomy offers comparable oncologic outcomes to lobectomy for lung cancer larger than 2 cm. This minimally invasive approach, guided by 3D-CTBA, shows similar long-term survival and recurrence rates.
Area of Science:
- Thoracic Surgery
- Surgical Oncology
- Pulmonology
Background:
- Segmentectomy is established for small non-small cell lung cancer (NSCLC).
- Its efficacy for larger tumors (>2-3 cm) compared to lobectomy is less understood.
Purpose of the Study:
- To compare oncologic outcomes of segmentectomy versus lobectomy for NSCLC tumors >2-3 cm.
- To evaluate the safety and long-term efficacy of 3D-CTBA guided segmentectomy.
Main Methods:
- Retrospective analysis of 430 patients with NSCLC >2-3 cm undergoing segmentectomy or lobectomy.
- Segmentectomy performed with 3D-CTBA guidance.
- Prognostic evaluation using log-rank test, Cox regression, and propensity score matching.
Main Results:
- No significant difference in postoperative complications between segmentectomy and lobectomy.
- Similar 5-year disease-free survival (89.1% vs. 91.8%) and overall survival (93.3% vs. 93.0%) after propensity score matching.
- Comparable long-term outcomes observed even for pure solid tumors or tumors with solid components >2 cm.
Conclusions:
- 3D-CTBA guided segmentectomy achieves equivalent long-term outcomes to lobectomy for selected cT1N0M0 NSCLC (>2-3 cm).
- Segmentectomy is a viable alternative to lobectomy for specific larger lung cancer cases.
