Application of preoperative three-dimensional reconstruction in single-port video-assisted thoracoscopic complex segmentectomy: a propensity matching analysis.

Abstract

Background: With the popularity of LDCT screening, more and more small lung cancers have been found, and segmentectomy has been widely used because of its advantages in the treatment of early lung cancer, but the feasibility of segmentectomy is still controversial because of the increased complexity of the operation. Especially in complex lung segment surgery, it is more controversial. Preoperative three-dimensional reconstruction (3DR) is one of the effective methods to ensure the smooth operation, but its role in complex segmentectomy has not yet been verified. This article aims to evaluate the value of preoperative three-dimensional reconstruction in complex pulmonary segmentectomy by retrospective analysis of preoperative three-dimensional reconstruction assisted single-port video-assisted thoracoscopic complex pulmonary segmentectomy and comparison of surgical related indicators.

Methods: The clinical data of patients with lung cancers who underwent single-port thoracoscopic complex segmentectomy (n = 299) from August 2015 to February 2019 were retrospectively analyzed, including 156 patients in the preoperative three-dimensional reconstruction group and 143 patients in the non-three-dimensional reconstruction group. Perioperative outcomes were compared between the two groups after comparative propensity score matching analysis (PSM) according to patient age, gender, BMI, lung function, smoking history, major tumor components, and tumor size.

Results: There were 125 patients in each group after PSM, and the baseline characteristics of patients were comparable. There were no significant differences in age, sex, BMI, smoking history, tumor histology and tumor size between the two groups (all P > 0.05). Lymph node dissection (9.4 ± 5.1 vs. 10.6 ± 7.0), postoperative drainage volume (510.5 ± 279.4 ml vs. 528.7 ± 379.4 ml), indwelling time of chest tube (2.3 ± 1.1d vs. 2.5 ± 1.6 d), and the incidence of chronic air leaks (0.8% vs. 0.8%), total complications (2.4% vs. 5.6%), 30-day postoperative mortality (0% vs. 0%) were not statistically different between the two groups. The operative time of preoperative 3DR group (178.6 ± 50.5 min vs. 202.1 ± 51.4 min), intraoperative blood loss (47.6 ± 37.9 ml vs. 58.4 ± 36.2 ml) compared with the control group (non-3DR), the difference was statistically significant (P < 0.05).

Conclusion: This is the first study to evaluate the usefulness of preoperative 3D reconstruction in complex segmentectomy. The results showed that the use of preoperative three-dimensional reconstruction for complex pulmonary segmentectomy was a safe and effective method, which could significantly reduce the operation time and blood loss.