Surgical outcomes using 3-dimensional image simulation for segmentectomy planning in patients with stage IA1-2 non-small cell lung cancer.

[OBJECTIVES] To evaluate perioperative and postoperative outcomes associated with commercial 3-dimensional reconstruction (3DR) modeling for preoperative planning of segmentectomy, and to assess the ability of 3DR to predict surgical margins.

[METHODS] Patients with clinical stage IA1-2 non-small cell lung cancer who underwent segmentectomy with or without 3DR (Control) from July 2021 to April 2025 were identified. Patients with previous surgery in the ipsilateral lung or pre-resection localization procedures were excluded. Patients who underwent planned thoracotomy were excluded from the postoperative outcomes analysis. A multivariable logistic regression model was used to assess the association between postoperative complications and clinical variables. The Spearman correlation coefficient was used to evaluate the relationship between 3DR-predicted margin and pathologic margin.

[RESULTS] A total of 266 patients were included (3DR group, n = 132; control group, n = 134). Patients in the 3DR group had fewer in-hospital complications and were less likely to require home oxygen on discharge. Achievement of complete resection, distance to the closest margin, rate of prolonged air leak, and readmission within 30 days were not statistically different by 3DR use. Overall operative time was not statistically different by 3DR use; however, among patients who underwent complex basilar segmentectomies, 3DR use was associated with shorter operative time (181 minutes vs 231 minutes), although the difference was not statistically significant (P = .13). 3DR-predicted margin was moderately correlated with pathologic margin (ρ = 0.622).

[CONCLUSIONS] The use of 3DR for segmentectomy planning was associated with fewer postoperative complications and shorter operative time in the setting of complex basilar segmentectomies.