To Study the Correlation Between the Anatomical Variation of Bronchial Vessels Identified by Preoperative...

All enrolled patients with non-small cell lung cancer (NSCLC) undergoing complex pulmonary segmentectomy received standardized preoperative three-dimensional (3D) computed tomography (CT) reconstruction. This study aimed to classify bronchovascular anatomical variations identified on preoperative 3D CT reconstruction and to examine their associations with postoperative complications (POCs), exploratory technical surrogate measures, and short-term postoperative rehabilitation.

From May 2022 to June 2025, a total of 170 patients with primary NSCLC who underwent thoracoscopic complex segmentectomy were included. All patients underwent preoperative thin-slice CT scanning and 3D reconstruction (Mimics 21.0). Anatomical variation patterns were identified by radiologists using a double-blind approach. Based on the presence of bronchovascular variations, patients were assigned to a variation group (n = 108) and a non-variation group (n = 62). POCs (defined as Clavien-Dindo grade II or higher), exploratory technical surrogate measures (minimum surgical margin distance and intersegmental plane integrity score), pathological indices (lymphatic invasion rate), and postoperative recovery parameters (pulmonary function and quality of life) were retrospectively extracted from medical records.

The overall incidence of POCs was significantly higher in the variation group compared with the non-variation group (p < 0.05), with a notable increase in persistent air leakage and pulmonary infections. For exploratory technical surrogate measures, the variation group showed a shorter minimum surgical margin distance, higher intersegmental plane integrity scores, and more frequent intraoperative plan adjustments (all p < 0.05). Pathological evaluation revealed a higher rate of lymphatic invasion in the variation group (p < 0.05), while no marked inter-group differences were observed in the number of positive lymph nodes (p > 0.05). In terms of postoperative recovery, patients in the variation group experienced a longer hospital stay, greater decline in 6-minute walking distance from baseline, and lower Short-Form 36 (SF-36) role-physical scores at 3 months postoperatively (all p < 0.05). All patients underwent standardized preoperative 3D CT reconstruction for anatomical assessment and surgical planning.

Bronchovascular anatomical variations identified through standardized preoperative 3D CT reconstruction were associated with higher rates of persistent air leakage (PAL), a higher rate of lymphatic invasion, pulmonary infection, less favorable exploratory technical surrogate measures, and delayed short-term postoperative functional recovery. Because all patients underwent 3D CT reconstruction, these findings should be interpreted as associations related to anatomical variation rather than evidence that 3D CT independently improves surgical decision-making or clinical outcomes.