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. 2025 Dec 5:S0022-5223(25)01042-6.
doi: 10.1016/j.jtcvs.2025.11.021. Online ahead of print.

Surgical outcomes using 3-dimensional image simulation for segmentectomy planning in patients with stage IA1-2 non-small cell lung cancer

Stella T Tsui  1 , Kay See Tan  2 , Junting Zheng  2 , Katherine D Gray  1 , Gaetano Rocco  1 , James M Isbell  1 , Smita Sihag  1 , Valerie W Rusch  1 , Robert J Downey  1 , Manjit S Bains  1 , Alexis P Chidi  1 , James Huang  1 , Prasad S Adusumilli  1 , Daniela Molena  1 , Bernard J Park  1 , David R Jones  1 , Matthew J Bott  3
Affiliations

Surgical outcomes using 3-dimensional image simulation for segmentectomy planning in patients with stage IA1-2 non-small cell lung cancer

Stella T Tsui et al. J Thorac Cardiovasc Surg. .

Abstract

Objectives: To evaluate perioperative and postoperative outcomes associated with commercial 3-dimensional reconstruction (3DR) modeling for preoperative planning of segmentectomy, and to assess the ability of 3DR to predict surgical margins.

Methods: Patients with clinical stage IA1-2 non-small cell lung cancer who underwent segmentectomy with or without 3DR (Control) from July 2021 to April 2025 were identified. Patients with previous surgery in the ipsilateral lung or pre-resection localization procedures were excluded. Patients who underwent planned thoracotomy were excluded from the postoperative outcomes analysis. A multivariable logistic regression model was used to assess the association between postoperative complications and clinical variables. The Spearman correlation coefficient was used to evaluate the relationship between 3DR-predicted margin and pathologic margin.

Results: A total of 266 patients were included (3DR group, n = 132; control group, n = 134). Patients in the 3DR group had fewer in-hospital complications and were less likely to require home oxygen on discharge. Achievement of complete resection, distance to the closest margin, rate of prolonged air leak, and readmission within 30 days were not statistically different by 3DR use. Overall operative time was not statistically different by 3DR use; however, among patients who underwent complex basilar segmentectomies, 3DR use was associated with shorter operative time (181 minutes vs 231 minutes), although the difference was not statistically significant (P = .13). 3DR-predicted margin was moderately correlated with pathologic margin (ρ = 0.622).

Conclusions: The use of 3DR for segmentectomy planning was associated with fewer postoperative complications and shorter operative time in the setting of complex basilar segmentectomies.

Keywords: 3D image reconstruction; preoperative planning; segmentectomy; stage I NSCLC.

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Conflict of interest statement

Conflict of Interest Statement Dr Rocco has financial relationships with Scanlan, Merck, and Medtronic. Dr Isbell has served as an advisory board member for AstraZeneca and Merck and as an uncompensated steering board member for Genentech; has received institutional research support from ArcherDx/Invitae, Guardant Health, GRAIL, and Intuitive Surgical and travel support from Intuitive Surgical; and has equity/ownership interest in LumaCyte. Dr Sihag serves on the AstraZeneca advisory board. Dr Adusumilli declares research funding from ATARA Biotherapeutics; is a scientific advisory board member and consultant for ATARA Biotherapeutics, Bayer, Bio4T2, Carisma Therapeutics, Imugene, ImmPactBio, Johnson & Johnson, Orion, and Outpace Bio; has patents, royalties, and intellectual property for T cell therapies licensed to ATARA Biotherapeutics; and has an issued patent method for detection of cancer cells using virus and pending patent applications on a PD-1–dominant negative receptor, a wireless pulse oximetry device, and an ex vivo malignant pleural effusion culture system. Dr Molena serves on a steering committee for AstraZeneca; consults for Johnson & Johnson, Bristol-Myers Squibb, AstraZeneca, and Boston Scientific; and has been an invited speaker for Merck and Genentech. Dr Park has received honoraria from Intuitive Surgical, AstraZeneca, and Medtronic; consults for Ceevra; and has received research support from Intuitive Surgical. Dr Jones serves on an advisory council for AstraZeneca and receives research grant support from Merck. Dr Bott consults for AstraZeneca, Iovance Biotherapeutics, and Intuitive Surgical and receives research support from Obsidian Therapeutics. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.

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