Anatomical Sublobar Resection for Multi-Intersegmental Pulmonary Nodules

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Pulmonary Medicine

Background:

• Anatomical sublobar resection (ASR) is comparable to lobectomy for peripheral small lung cancers.
• ASR presents challenges for nodules in complex, multi-intersegmental locations.

Purpose of the Study:

• To compare the perioperative and oncological outcomes of ASR versus lobectomy for multi-intersegmental pulmonary nodules.
• To evaluate the feasibility and efficacy of ASR in complex tumor locations.

Main Methods:

• Retrospective analysis of patients with small pulmonary nodules (≤2 cm) undergoing ASR or lobectomy (2012-2023).
• Utilized 3D multiplanar reconstruction for precise tumor localization.
• Compared demographic, radiomic, histopathologic, and perioperative data.
• Employed propensity score-matching (PSM) for robust comparison.

Main Results:

• ASR group (93 patients) had younger patients, smaller tumors, fewer solid nodules, and more central nodules than the lobectomy group (118 patients).
• ASR preserved more lung segments (12 vs. 5), with comparable surgical margins and no increase in air leaks or hospital stay.
• Five-year recurrence-free survival was 100% for ASR versus 95.4% for lobectomy, with 100% RFS in both groups post-PSM.

Conclusions:

• ASR is a feasible surgical option for multi-intersegmental pulmonary nodules.
• ASR effectively preserves pulmonary parenchyma with oncological outcomes equivalent to lobectomy.
• ASR offers a viable alternative to lobectomy, particularly in complex nodule locations.