Planning of segmentectomy using three-dimensional computed tomography angiography with a virtual safety margin: Technique and initial experience

Abstract

ObjectivesIn preoperative segmentectomy simulation for primary lung cancer, it is important to identify the intersegmental pulmonary veins and the relationship between them and the surgical safety margin. We have adopted a method that incorporates a virtual safety margin into three-dimensional computed tomography angiography images in order to plan adequate segmentectomy for lung cancer patients. In this study, we describe the new preoperative planning technique and review cases in which we performed segmentectomy based on its results. MethodsWe reviewed clinical, radiological, and pathological records and selected patients who underwent segmentectomy for a primary lung cancer lesion with a diameter of 2cm or less. These segmentectomies were planned using preoperative three-dimensional computed tomography angiography with a virtual safety margin. ResultsA total of 17 primary lung cancers in 16 patients (11 male and 5 female, aged 52–82 years) were removed by segmentectomy, planned using the new technique. In 6 of 17 tumors (35%) were non-solid type adenocarcinomas, 3 tumors (18%) were partly solid type adenocarcinomas, 6 tumors (35%) were solid type adenocarcinomas and 2 tumors (12%) were squamous cell carcinomas. Pathological examination revealed no positive surgical margins and no lymph node metastases in any patients. ConclusionsThree-dimensional computed tomography angiography with a virtual safety margin was able to non-invasively visualize the three-dimensional distances and the relationships between the primary tumor and intersegmental pulmonary veins. It was able to aid in the preoperative planning of a suitable segmentectomy procedure for patients with a primary lung cancer lesion of 2cm or less in diameter.