Three-dimensional reconstruction for determining positional indications of pulmonary segmentectomy/subsegmentectomy for ground glass opacity-dominant clinical T1a-bN0 non-small cell lung cancer

Chengyu Bian; Chenghao Fu; Wentao Xue; Yan Gu; Hongchang Wang; Wenhao Zhang; Guang Mu; Mei Yuan; Liang Chen; Jingjing Huang; Qianyun Wang; Jun Wang

doi:10.21037/tlcr-24-595

Three-dimensional reconstruction for determining positional indications of pulmonary segmentectomy/subsegmentectomy for ground glass opacity-dominant clinical T1a-bN0 non-small cell lung cancer

Transl Lung Cancer Res. 2024 Nov 30;13(11):2947-2957. doi: 10.21037/tlcr-24-595. Epub 2024 Nov 28.

Authors

Chengyu Bian^#^{1

2}, Chenghao Fu^#², Wentao Xue², Yan Gu², Hongchang Wang², Wenhao Zhang^{2

3}, Guang Mu², Mei Yuan⁴, Liang Chen², Jingjing Huang^#⁵, Qianyun Wang^#¹, Jun Wang^#²

Affiliations

¹ Department of Thoracic Surgery, The First People's Hospital of Changzhou and The Third Affiliated Hospital of Soochow University, Changzhou, China.
² Department of Thoracic Surgery, Jiangsu Province Hospital and The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
³ Department of Cardiothoracic Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China.
⁴ Department of Radiology, Jiangsu Province Hospital and The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
⁵ Department of Cardiothoracic Surgery, Affiliated Hospital of Jiangsu University, Zhenjiang, China.

^# Contributed equally.

Abstract

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.

Keywords: Segmentectomy; positional indication; subsegmentectomy; surgical margin.