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.	胡義, 阿卜拉·努爾麥麥提, 穆熱迪力·麥麥提阿卜杜拉, 等. 基于CT三維重建技術對肺部病變患側肺段支氣管解剖類型及變異情況的影像學觀察. 中華解剖與臨床雜志, 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.	王騰騰, 劉寶東, 張毅, 等. 術前輔助定位聯合CT三維重建在以肺結節為中心的單孔胸腔鏡聯合亞段/肺段切除術中的應用. 中國胸心血管外科臨床雜志, 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.	許德新, 陳新富. 胸腔鏡下復雜肺段切除術吲哚菁綠熒光反染法與改良膨脹萎陷法的對比研究. 中國微創外科雜志, 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.	陳培, 樊勝明, 李曙剛. 三維重建技術在胸腔鏡肺癌根治手術中的應用價值. 浙江創傷外科, 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.	葉春林, 喻本桐. 三維CT支氣管血管成像技術在精準肺段切除中應用的研究進展. 中國醫師雜志, 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. 胡義, 阿卜拉·努爾麥麥提, 穆熱迪力·麥麥提阿卜杜拉, 等. 基于CT三維重建技術對肺部病變患側肺段支氣管解剖類型及變異情況的影像學觀察. 中華解剖與臨床雜志, 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. 王騰騰, 劉寶東, 張毅, 等. 術前輔助定位聯合CT三維重建在以肺結節為中心的單孔胸腔鏡聯合亞段/肺段切除術中的應用. 中國胸心血管外科臨床雜志, 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. 許德新, 陳新富. 胸腔鏡下復雜肺段切除術吲哚菁綠熒光反染法與改良膨脹萎陷法的對比研究. 中國微創外科雜志, 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. 陳培, 樊勝明, 李曙剛. 三維重建技術在胸腔鏡肺癌根治手術中的應用價值. 浙江創傷外科, 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. 葉春林, 喻本桐. 三維CT支氣管血管成像技術在精準肺段切除中應用的研究進展. 中國醫師雜志, 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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