Three-Dimensional Images for Thoracoscopic Segmentectomy: An Alternative to Preoperative Localization

Introduction: This study aimed to compare the outcomes of three-dimensional (3D) image- guided video-assisted thoracic surgery (VATS) segmentectomy performed with and without preoperative localization for the resection of small pulmonary nodules. Method: Between July 2015 and December 2022, 439 patients who underwent 3D image- guided VATS segmentectomy for early-stage lung cancer were enrolled. Based on whether preoperative localization was performed, the patients were divided into two groups as follows: the localization (n = 96) and nonlocalization groups (n = 343). The primary endpoints were the resection success rate and surgical margins. : Resection was successfully performed in 95 (99.0%) and 340 (99.1%) patients in the localization and nonlocalization groups, respectively (P = 1.000). One and three patients in the localization and nonlocalization groups, respectively, required conversion to extended segmentectomy due to inadequate surgical margins. The median surgical margins were 20 (range, 14-30) mm and 22 (range, 14-30) mm in the localization and nonlocalization groups, respectively (P = 0.410). However, overall complications were significantly more frequent in the localization group (9.4%) than in the nonlocalization group (4.1%; P = 0.040). This result was further supported by findings from multivariate logistic regression analysis. A subgroup analysis of high-risk small pulmonary nodules indicated no statistically significant differences between the groups concerning the primary endpoints. Conclusions: 3D image-guided VATS segmentectomy performed with and without preoperative localization had comparable resection success rates and surgical margins. However, the procedure without preoperative localization was associated with fewer postoperative complications. (c) 2024 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.