10. Surgical Outcomes in Utilization of Three-Dimensional Image Simulation for Segmentectomy Planning in Patients with Stage IA1-2 Non-small Cell Lung Cancer

Objective: To evaluate the perioperative and post-operative outcomes of using three-dimensional reconstruction modeling (3DR) in preoperative planning of segmentectomy in clinical stage IA1-2 non-small cell lung cancer (NSCLC) patients.

Methods: Patients with clinical stage IA1-2 NSCLC who underwent segmentectomy either with (3DR) or without (Control) three-dimensional imaging reconstruction from July 2021 to February 2025 at a single institution were identified from a prospectively maintained surgical database. Patients with previous thoracic surgery in the ipsilateral lung and patients with pre-resection localization procedure were excluded. Fisher's exact test and Wilcoxon rank sum test were used to compare categorical and continuous variables respectively between the cohorts. A multivariable logistic regression model was used to assess the association between in-hospital complications and clinical variables.

Results: In total, 253 patients underwent segmentectomy for clinical stage IA1-2 NSCLC. There were 125 patients in the 3DR group and 128 patients in the Control group. 3DR was more commonly used in patients with tumors in right upper lobe (24% vs 13%), left apical trisegment (36% vs 31%) and basilar segments (21% vs 16%, p=0.007). Open thoracotomy, either planned (0.8% vs 6.3%) or conversion (1.6% vs 3.1%), was less frequent in the 3DR group compared to the Control group (p=0.050). More robotic resections (82% vs 59%, p<0.001) and complex segmentectomies (60% vs 30%, p<0.001) were performed in the 3DR group. In regard to operative outcomes, there were no differences in the rate of additional margin resection (9.6% vs 13%, p=0.431), rate of complete R0 resection (98% vs 99%, p=0.619) or distance of closest margin (1.20 cm vs 1.20 cm, p=0.371) between the two groups. While there was no difference in overall operative times between the 3DR and Control groups (180 minutes vs 189 minutes, p=0.217), subgroup analysis of patients undergoing complex basilar segmentectomies demonstrated decreased operative time in the 3DR group compared to the Control group (181 minutes vs. 231 minutes, p=0.13). After excluding patients who had planned thoracotomy from the post-operative variable analysis, patients in the 3DR group had fewer in-hospital complications (9.7% vs 23%, p=0.005) and were less likely to require home oxygen on discharge (0 vs 5.0%, p=0.013). However, there were no differences in hospital length of stay (2 days vs 2 days, p=0.821), chest tube duration (1 day vs 2 days, p=0.164), rate of air leak (24% vs 32%, p=0.196) or rate of readmission within 30 days (3.2% vs 4.2%, p=0.746) between the two groups. After adjusting for clinical variables in a multivariable analysis, the use of 3DR (OR 0.42, 95% CI 0.20-0.89; p=0.023) remained the sole significant variable associated with a decrease in in-hospital complications (Table 1).

Conclusions: The application of three-dimensional reconstruction models to segmentectomy planning in stage IA1-2 NSCLC patients demonstrated a reduction in post-operative complications. While margin adequacy appeared similar between the two groups, use of 3DR may also be associated with decreased operative time in the setting of complex basilar segmentectomies.

Stella Tsui (1), Kay See Tan (1), Junting Zheng (2), Katherine Gray (1), Gaetano Rocco (1), James Isbell (1), Smita Sihag (1), Valerie Rusch (1), Robert Downey (1), Manjit Bains (3), Alexis Chidi (4), James Huang (1), Prasad Adusumilli (1), Daniela Molena (1), Bernard Park (1), David Jones (1), Matthew Bott (5), (1) Memorial Sloan Kettering Cancer Center, New York, NY, (2) Memorial Sloan Kettering, New York, NY, (3) Memorial Sloan Kettering Cancer Center, Cresskill, NJ, (4) Memorial Sloan Kettering Cancer Center, Rancho Palos Verdes, CA, (5) Memorial Sloan-Kettering Cancer Center, Ho Ho Kus, NJ

Shawn Groth

Invited Discussant

Shawn S. Groth, M.D., is Chief of the Division of Thoracic Surgery at Baylor College of Medicine.  He serves as the director of Esophageal Surgical Services at Baylor St. Luke’s Medical Center, and co-directs a center that provides a multidisciplinary approach to managing patients with gastroesophageal reflux disease and esophageal motility disorders.  Dr. Groth’s practice includes the management of benign and malignant disorders of the esophagus and foregut, lung, pleural space, mediastinum, chest wall, and diaphragm.  Dr. Groth is an expert in advanced endoscopy, including per oral endoscopic myotomy (POEM), and robotic thoracic surgery.   He serves on the editiorial boards of multiple major medical journals, including the Annals of Thoracic Surgery, the Journal of Gastrointestinal Surgery, and the Journal of Thoracic and Cardiovascular Surgery.  His clinical research focuses on thoracic oncology clinical trials and health services research to identify health care disparities and improve quality of care. 

Stella Tsui

Abstract Presenter

Stella Tsui is a fourth year general surgery resident at New York Presbyterian-Weill Cornell Medical Center. She is currently completing a two year thoracic research fellowship at Memorial Sloan Kettering Cancer Center under Dr. David Jones.