Simulation and navigation techniques in segmentectomy for lung cancer

Abstract

: The diagnostic imaging technology for lung nodules has improved because of advances in computed tomography (CT) equipment. Therefore, surgical resections have increased for small-sized lung cancers or low-grade lung cancers with ground-glass opacity (GGO) that are not detected on chest radiographs. A recent Japanese prospective randomized study of segmentectomy versus standard lobectomy for small-sized lung cancer revealed better overall survival (OS) in the segmentectomy group, which supports segmentectomy for lung cancer patients. However, this prospective trial showed that postoperative recurrences were more frequent in the segmentectomy group than in the lobectomy group. In clinical practice, intentional segmentectomy for the lung has been indicated for lung cancer patients as several retrospective studies have shown favorable outcomes. The usefulness of a three-dimensional (3D) understanding of segmental anatomy has been reported, and new complex segmentectomies have been developed using 3D simulation. Advances in 3D-CT technology and simulation software provide precise preoperative simulation for surgical procedures that enable understanding of complex bronchovascular anatomy and 3D measurement of the surgical margin. A precise 3D simulation allows surgeons to perform safer complex segmentectomies. Hence, we can expect a better postoperative quality of life and improved survival by reducing the amount of resected parenchyma. We reviewed the expanding indications for lung segmentectomy and the growing demand for 3D simulation technology, including its advantages and limitations. We believe that this field will develop further as technology continues to advance.