P3.04-020 Segmentectomy in Patients with Pulmonary Malignancies Using 3D-CT Reconstruction and Bronchovascular Separation

Progress in diagnostics and surgery in thoracic oncology is associated with increasing number of patients-candidates for sublobar anatomic pulmonary resection. Vascular variability of pulmonary segments anatomy requires special tools for individual preoperative planning. 84 patients who underwent segmentectomy due to low pulmonary function, severe comorbidity, previous history of lung resection and metastatic lesion were included at the retrospective trial from prospectively collected database. Inclusion criteria were clinical T1aN0M0 peripheral non-small cell lung cancer (NSCLC) measuring ≤2 cm (n=23) and resectable pulmonary metastases not suitable for wedge resection due to deep parenchymal location (n=61). Segmentectomies were divided into typical (where parenchymal division involves 2 planes) and atypical (more complex and technically demanding, when the segmental excision involves 3 planes). 19 patients underwent VATS segmentectomy. Three-dimensional computed tomography (3D-CT) with bronchovascular separation was used preoperatively in 32 patients from October 2014 to May 2016. Mortality, morbidity, proportion of typical versus atypical and VATS versus open segmentectomies in two groups: with or without 3D-CT bronchovascular reconstruction, were compared. There was no mortality in whole group. Morbidity rate was 14% not exceeding grade 3a according thoracic mortality and morbidity (TMM) score. The difference in morbidity rate was not statistically significant between two groups (15,3% and 12,5%; p=0,64) The most common complication was prolonged air leak > 7 days (8%). 3D-CT powered by separation of arterial, venous and bronchial structures enabled surgeons to perform atypical segmentectomies and use VATS approach more often (37% vs 4% and 42% vs 16%, respectively). 7 atypical segmentectomies were performed by VATS due to 3D-CT reconstruction with bronchovascular separation. 3D-CT reconstruction with bronchovascular separation provides precise preoperative planning of individual pulmonary segments anatomy and enables to increase the proportion of atypical and VATS sublobar anatomic pulmonary resections.