BACKGROUND: Variations in bronchovascular segmental anatomy are often challenging to understand based on conventional two-dimensional (2D) computed tomography (CT) scans. Preoperative lung three-dimensional (3D) segmentation allows accurate identification of bronchovascular anatomy of lung segments and successful performance of anatomic lung segmentectomy.
METHODS: We report a case of a 76-year-old female patient with a history of smoking, who was incidentally found to have a 1.8 cm nodule in the right upper lobe anterior segment.
Positron emission tomography (PET) CT scan showed increased uptake with standardized uptake value (SUV) of 4.2 without evidence of nodal or extrathoracic disease.
Robotic bronchoscopic biopsy confirmed squamous carcinoma of the lung. Preoperative planning with lung segmentation software showed the lesion ideally located for right upper S3 segmentectomy with adequate oncologic margins.
RESULTS:We performed a robotic assisted right upper lobe S3 segmentectomy along with hilar and mediastinal dissection. The S3 segment, and relevant venous and arterial branches, were identified as per preoperative planning.
The patient recovered uneventfully and was discharged home on postoperative day 2. Final pathology found a 1.8 cm squamous cell carcinoma with one hilar lymph node positive for metastatic disease, with final stage as pT1bN1M0 (pathologic stage IIB) and PDL1 > 1%. The patient was appropriately referred to the medical oncologist for adjuvant chemoimmunotherapy.
CONCLUSIONS:Advanced 3D lung segmentation and reconstruction allows for the accurate identification of clinically relevant bronchovascular anatomy and the planning and simulation for appropriate intersegmental parenchymal margins.
