Application value of preoperative three-dimensional reconstruction in the resection of lung nodules: A retrospective cohort study in a single center_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

QI Fei ¹ , FENG Hongxiang ² , ZHU Weijie ² , SHI Yuhui ² , LIU Deruo ² , LIANG Chaoyang ² ,  ZHANG Zhenrong ²

1. China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100029, P. R. China;
2. Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, 100029, P. R. China;

Corresponding author：

ZHANG Zhenrong, Email: doctor_zzr@126.com

Keywords：

Three-dimensional reconstruction; thoracoscopic surgery; lung cancer; segmentectomy

DOI：

10.7507/1007-4848.202312053

Video：

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Objective To explore the guiding significance of preoperative 3D reconstruction for pulmonary nodule location and thoracoscopic surgical method selection in lung cancer patients. Methods The clinical data of the patients with preoperative 3D reconstruction in our China-Japan Friendship Hospital between January and November 2023 were retrospectively analyzed. Preoperative surgical planning was performed using 3D reconstruction. Different surgical procedure, including wedge resection, segmentectomy, lobectomy, or combined surgical procedure were performed based on tumor location, size and distance from the pleura. Results A total of 115 patients were included with 45 males and 70 females, at an average age of 25-84 (58.29±11.36) years and successfully completed the operation. Fifty-five (47.8%) patients' nodule diameter was tangent cross-section, among whom twenty-five (21.7%) patients of nodules crossed sections. There were 21 patients of wedge resection in the outer 1/3 nodules of CT, which had shorter operation time and less cost (P<0.001) and less intraoperative bleeding (P=0.019). For the crossing sections or edge crossing sections nodules of the middle and inner of CT, 6 patients were of simple pulmonary segmentectomy, 8 patients of combined with sub-segmentectomy, 7 patients of combined segmentectomy, 5 patients of lobectomy, and 3 patients of wedge resection. Conclusion The proportion of cross-segment pulmonary nodules is relatively high. For the outer 1/3 nodules of CT, compared with pulmonary segmental resection combined with adjacent lung tissue resection, wedge resection can also ensure sufficient surgical margin, and the middle and inner 1/3 nodules of CT need to be combined with adjacent pulmonary tissue resection to ensure the surgical edge.

Citation： QI Fei, FENG Hongxiang, ZHU Weijie, SHI Yuhui, LIU Deruo, LIANG Chaoyang, ZHANG Zhenrong. Application value of preoperative three-dimensional reconstruction in the resection of lung nodules: A retrospective cohort study in a single center. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(10): 1407-1412. doi: 10.7507/1007-4848.202312053 Copy

1.	Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg, 1995, 60(3): 615-623.
2.	Lang-Lazdunski L. Surgery for nonsmall cell lung cancer. Eur Respir Rev, 2013, 22(129): 382-404.
3.	Okada M, Koike T, Higashiyama M, et al. Radical sublobar resection for small-sized non-small cell lung cancer: A multicenter study. J Thorac Cardiovasc Surg, 2006, 132(4): 769-775.
4.	Suzuki K, Saji H, Aokage K, et al. Comparison of pulmonary segmentectomy and lobectomy: Safety results of a randomized trial. J Thorac Cardiovasc Surg, 2019, 158(3): 895-907.
5.	Suzuki K, Watanabe SI, Wakabayashi M, et al. A single-arm study of sublobar resection for ground-glass opacity dominant peripheral lung cancer. J Thorac Cardiovasc Surg, 2022, 163(1): 289-301 e2.
6.	Altorki NK, Wang X, Wigle D, et al. Perioperative mortality and morbidity after sublobar versus lobar resection for early-stage non-small-cell lung cancer: Post-hoc analysis of an international, randomised, phase 3 trial (CALGB/Alliance 140503). Lancet Respir Med, 2018, 6(12): 915-924.
7.	Altorki NK, Yip R, Hanaoka T, et al. Sublobar resection is equivalent to lobectomy for clinical stage 1A lung cancer in solid nodules. J Thorac Cardiovasc Surg, 2014, 147(2): 754-762.
8.	胡义, 阿卜拉·努尔麦麦提, 穆热迪力·麦麦提阿卜杜拉, 等. 基于CT三维重建技术对肺部病变患侧肺段支气管解剖类型及变异情况的影像学观察. 中华解剖与临床杂志, 2023, 28(6): 365-375.Hu Y, Nurmamat A, Mamatabdulla M, et al. Observation of the anatomical types and variations of pulmonary segment bronchus on the side of pulmonary lesions based on multi-slice spiral CT three-dimensional reconstruction technique. Chin J Anat Clin, 2023, 28(6): 365-375.
9.	王腾腾, 刘宝东, 张毅, 等. 术前辅助定位联合CT三维重建在以肺结节为中心的单孔胸腔镜联合亚段/肺段切除术中的应用. 中国胸心血管外科临床杂志, 2023, 30(3): 364-368.Wang TT, Liu BD, Zhang Y, et al. Application of preoperative localization coupled with CT three-dimensional reconstruction in pulmonary nodule-centered uniportal thoracoscopic combined subsegmental/segmental resection. Chin J Clin Thorac Cardiovasc Surg, 2023, 30(3): 364-368.
10.	Zhang X, Li C, Jin R, et al. Intraoperative identification of the intersegmental plane: From the beginning to the future. Front Surg, 2022, 9: 948878.
11.	许德新, 陈新富. 胸腔镜下复杂肺段切除术吲哚菁绿荧光反染法与改良膨胀萎陷法的对比研究. 中国微创外科杂志, 2023, 23(5): 325-331.Xu DX, Chen XF. A comparison study of indocyanine green fluorescence reverse staining method and modified inflation-collapse method in thoracoscopic complex segmentectomy. Chin J Minim Invasive Surg, 2023, 23(5): 325-331.
12.	陈培, 樊胜明, 李曙刚. 三维重建技术在胸腔镜肺癌根治手术中的应用价值. 浙江创伤外科, 2023, 28(4): 690-692.Chen P, Fan SM, Li SG, et al. The application value of 3D reconstruction technology in thoracoscopic radical surgery for lung cancer. Zhejiang J Trauma Surg, 2023, 28(4): 690-692.
13.	Handa Y, Tsutani Y, Mimae T, et al. Surgical procedure selection for stage Ⅰ lung cancer: Complex segmentectomy versus wedge resection. Clin Lung Cancer, 2021, 22(2): e224-e233.
14.	Moon MH, Moon YK, Moon SW. Segmentectomy versus lobectomy in early non-small cell lung cancer of 2 cm or less in size: A population-based study. Respirology, 2018, 23(7): 695-703.
15.	Saji H, Okada M, Tsuboi M, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): A multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet, 2022, 399(10335): 1607-1617.
16.	Shi Y, Wu S, Ma S, et al. Comparison between wedge resection and lobectomy/segmentectomy for early-stage non-small cell lung cancer: A Bayesian meta-analysis and systematic review. Ann Surg Oncol, 2022, 29(3): 1868-1879.
17.	叶春林, 喻本桐. 三维CT支气管血管成像技术在精准肺段切除中应用的研究进展. 中国医师杂志, 2019, 21(11): 1601-1604.Ye CL, Yu BT. Research progress on the application of three-dimensional CT bronchial vascular imaging technology in precise lung segmentectomy. J Chin Physic, 2019, 21(11): 1601-1604.
18.	Seguin-Givelet A, Grigoroiu M, Brian E, et al. Planning and marking for thoracoscopic anatomical segmentectomies. J Thorac Dis, 2018, 10(Suppl 10): S1187-S1194.

1. Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg, 1995, 60(3): 615-623.
2. Lang-Lazdunski L. Surgery for nonsmall cell lung cancer. Eur Respir Rev, 2013, 22(129): 382-404.
3. Okada M, Koike T, Higashiyama M, et al. Radical sublobar resection for small-sized non-small cell lung cancer: A multicenter study. J Thorac Cardiovasc Surg, 2006, 132(4): 769-775.
4. Suzuki K, Saji H, Aokage K, et al. Comparison of pulmonary segmentectomy and lobectomy: Safety results of a randomized trial. J Thorac Cardiovasc Surg, 2019, 158(3): 895-907.
5. Suzuki K, Watanabe SI, Wakabayashi M, et al. A single-arm study of sublobar resection for ground-glass opacity dominant peripheral lung cancer. J Thorac Cardiovasc Surg, 2022, 163(1): 289-301 e2.
6. Altorki NK, Wang X, Wigle D, et al. Perioperative mortality and morbidity after sublobar versus lobar resection for early-stage non-small-cell lung cancer: Post-hoc analysis of an international, randomised, phase 3 trial (CALGB/Alliance 140503). Lancet Respir Med, 2018, 6(12): 915-924.
7. Altorki NK, Yip R, Hanaoka T, et al. Sublobar resection is equivalent to lobectomy for clinical stage 1A lung cancer in solid nodules. J Thorac Cardiovasc Surg, 2014, 147(2): 754-762.
8. 胡义, 阿卜拉·努尔麦麦提, 穆热迪力·麦麦提阿卜杜拉, 等. 基于CT三维重建技术对肺部病变患侧肺段支气管解剖类型及变异情况的影像学观察. 中华解剖与临床杂志, 2023, 28(6): 365-375.Hu Y, Nurmamat A, Mamatabdulla M, et al. Observation of the anatomical types and variations of pulmonary segment bronchus on the side of pulmonary lesions based on multi-slice spiral CT three-dimensional reconstruction technique. Chin J Anat Clin, 2023, 28(6): 365-375.
9. 王腾腾, 刘宝东, 张毅, 等. 术前辅助定位联合CT三维重建在以肺结节为中心的单孔胸腔镜联合亚段/肺段切除术中的应用. 中国胸心血管外科临床杂志, 2023, 30(3): 364-368.Wang TT, Liu BD, Zhang Y, et al. Application of preoperative localization coupled with CT three-dimensional reconstruction in pulmonary nodule-centered uniportal thoracoscopic combined subsegmental/segmental resection. Chin J Clin Thorac Cardiovasc Surg, 2023, 30(3): 364-368.
10. Zhang X, Li C, Jin R, et al. Intraoperative identification of the intersegmental plane: From the beginning to the future. Front Surg, 2022, 9: 948878.
11. 许德新, 陈新富. 胸腔镜下复杂肺段切除术吲哚菁绿荧光反染法与改良膨胀萎陷法的对比研究. 中国微创外科杂志, 2023, 23(5): 325-331.Xu DX, Chen XF. A comparison study of indocyanine green fluorescence reverse staining method and modified inflation-collapse method in thoracoscopic complex segmentectomy. Chin J Minim Invasive Surg, 2023, 23(5): 325-331.
12. 陈培, 樊胜明, 李曙刚. 三维重建技术在胸腔镜肺癌根治手术中的应用价值. 浙江创伤外科, 2023, 28(4): 690-692.Chen P, Fan SM, Li SG, et al. The application value of 3D reconstruction technology in thoracoscopic radical surgery for lung cancer. Zhejiang J Trauma Surg, 2023, 28(4): 690-692.
13. Handa Y, Tsutani Y, Mimae T, et al. Surgical procedure selection for stage Ⅰ lung cancer: Complex segmentectomy versus wedge resection. Clin Lung Cancer, 2021, 22(2): e224-e233.
14. Moon MH, Moon YK, Moon SW. Segmentectomy versus lobectomy in early non-small cell lung cancer of 2 cm or less in size: A population-based study. Respirology, 2018, 23(7): 695-703.
15. Saji H, Okada M, Tsuboi M, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): A multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet, 2022, 399(10335): 1607-1617.
16. Shi Y, Wu S, Ma S, et al. Comparison between wedge resection and lobectomy/segmentectomy for early-stage non-small cell lung cancer: A Bayesian meta-analysis and systematic review. Ann Surg Oncol, 2022, 29(3): 1868-1879.
17. 叶春林, 喻本桐. 三维CT支气管血管成像技术在精准肺段切除中应用的研究进展. 中国医师杂志, 2019, 21(11): 1601-1604.Ye CL, Yu BT. Research progress on the application of three-dimensional CT bronchial vascular imaging technology in precise lung segmentectomy. J Chin Physic, 2019, 21(11): 1601-1604.
18. Seguin-Givelet A, Grigoroiu M, Brian E, et al. Planning and marking for thoracoscopic anatomical segmentectomies. J Thorac Dis, 2018, 10(Suppl 10): S1187-S1194.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Application value of preoperative three-dimensional reconstruction in the resection of lung nodules: A retrospective cohort study in a single center

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