3DCT reconstruction-does 3DCT improve anatomical lung resection?-a narrative review of the literature

Minimally invasive and sublobar anatomical lung resection has become the gold standard for stage I non-small cell lung cancer (NSCLC) under 2 cm. Preoperative surgical planning with three-dimensional computed tomography (3DCT) reconstruction has become more common to improve safety and accuracy of resection. The aim of this review is to evaluate the evidence for 3DCT reconstruction in improving perioperative outcomes in patients undergoing anatomical lung resection.

A targeted literature review of evidence for 3DCT reconstruction in the perioperative period, focusing on quantitative data. Studies were included if they offered comparative data between two-dimensional computed tomography (2DCT) and 3DCT, or if they reported outcomes directly influenced using 3D imaging. Articles were excluded if they did not address preoperative imaging strategies, lacked peer review, or failed to provide sufficient data for analysis.

Forty papers were identified for this review. Seventeen only described bronchovascular patterns and anatomical variations with no surgical procedure performed and were excluded. Twenty-three described 3DCT reconstruction in relation to surgical resection. Nine studies assessed resection margins, with one reporting a change from segmentectomy to lobectomy due to 3DCT findings (10.5%). Two showed improved margin adequacy with 3DCT, though overall evidence remains limited. Across six comparative studies, two reported reduced blood loss with 3DCT, while others showed no difference. Operative time showed mixed results: three retrospective studies reported shorter durations, though the single randomised controlled trial, the DRIVATS study, found no difference. There was also no difference in clinical outcomes such as chest tube drainage, postoperative complications and postoperative hospital stay. However, this may be due to segmentectomy being a heterogeneous group of operations, as well as underpowered studies.

Although randomized evidence demonstrating the superiority of 3DCT reconstruction over conventional computed tomography (CT) is lacking, 3DCT remains a valuable adjunct for visualising complex anatomical structures and guiding operative planning.