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Updated: Jun 5, 2025
Author Spotlight: Advancing 3D Modeling for Enhanced Diagnosis and Treatment of Pulmonary Nodules in Early-Stage Lung Cancer
Published on: October 13, 2023
Three-dimensional reconstruction for determining positional indications of pulmonary segmentectomy/subsegmentectomy
Chengyu Bian1,2, Chenghao Fu2, Wentao Xue2
1Department of Thoracic Surgery, The First People's Hospital of Changzhou and The Third Affiliated Hospital of Soochow University, Changzhou, China.
Background:
The precision of segmentectomy/subsegmentectomy for ground glass opacity (GGO)-dominant cT1a-bN0 non-small cell lung cancer (NSCLC), including mono-segmentectomy, mono-subsegmentectomy, combined subsegmentectomies, and single segmentectomy with adjacent subsegmentectomy, has improved. The aim of this study is to investigate their positional indications by focusing on the three-dimensional location of lesions, utilizing three-dimensional computed tomography bronchography and angiography (3D-CTBA).
Methods:
We retrospectively analyzed 195 patients with GGO-dominant cT1a-bN0 NSCLC who underwent segmentectomy/subsegmentectomy between August 2015 and November 2020. We included 173 patients: mono-segmentectomy (71, 41.04%), mono-subsegmentectomy (37, 21.39%), combined subsegmentectomies (42, 24.28%), and single segmentectomy with adjacent subsegmentectomy (23,13.29%). Patient demographics and perioperative outcomes were compared among groups to identify positional indications.
Results:
Significant differences were observed among the four groups in terms of lobe location of the lesions and their relationships with adjacent intersegmental veins (P<0.001), but not in their diameter and depth (P=0.33; P=0.79). All groups showed similar surgical margins (P=0.77) despite differences in the number of subsegments resected (P<0.001). No perioperative deaths or postoperative recurrences were reported. For lesions located in the middle region, located inter-segmentally, or with a diameter >1 cm, a greater number of subsegments were resected (P=0.02; P<0.001; P=0.003), while the surgical margins were not inferior to those located in the outer region, located intra-segmentally, or with a diameter ≤1 cm (P=0.29; P=0.77; P=0.46).
Conclusions:
It is the specific lobe in which lesions are located and their relationship with adjacent intersegmental veins that determine the specific surgical procedure of segmentectomy/subsegmentectomy for GGO-dominant cT1a-bN0 NSCLC, rather than their diameter and depth.
Insights
Precise segmentectomy/subsegmentectomy for ground glass opacity-dominant non-small cell lung cancer depends on lesion location within the lobe and proximity to intersegmental veins, not size or depth. This guides surgical approach for optimal outcomes in early-stage lung cancer.
Area of Science:
- Thoracic Surgery
- Surgical Oncology
- Pulmonology
Background:
- Segmentectomy and subsegmentectomy precision has improved for ground glass opacity (GGO)-dominant non-small cell lung cancer (NSCLC).
- Accurate surgical planning is crucial for GGO-dominant cT1a-bN0 NSCLC.
- Three-dimensional computed tomography bronchography and angiography (3D-CTBA) aids in visualizing lesion location.
Purpose of the Study:
- To investigate the positional indications for segmentectomy/subsegmentectomy in GGO-dominant cT1a-bN0 NSCLC.
- To determine if lesion location influences surgical approach.
- To correlate lesion characteristics with surgical outcomes.
Main Methods:
- Retrospective analysis of 173 patients with GGO-dominant cT1a-bN0 NSCLC who underwent segmentectomy/subsegmentectomy.
- Categorization into mono-segmentectomy, mono-subsegmentectomy, combined subsegmentectomies, and single segmentectomy with adjacent subsegmentectomy.
- Comparison of patient demographics, perioperative outcomes, and lesion characteristics using 3D-CTBA.
Main Results:
- Lobe location and relationship with intersegmental veins significantly differed among surgical groups (P<0.001).
- Lesion diameter and depth did not show significant differences (P=0.33; P=0.79).
- Surgical margins were similar across groups despite variations in resected subsegments; no perioperative deaths or recurrences were reported.
Conclusions:
- The specific lobe and proximity to intersegmental veins are key determinants for segmentectomy/subsegmentectomy in GGO-dominant NSCLC.
- Lesion diameter and depth are less critical factors in surgical planning for these procedures.
- This study provides insights into optimizing surgical strategies based on lesion position.
