Superselective Segmentectomy for Deep and Small Pulmonary Nodules Under the Guidance of Three-Dimensional Reconstructed Computed Tomographic Angiography

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Superselective Segmentectomy for Deep and Small Pulmonary Nodules Under the Guidance of Three-Dimensional Reconstructed Computed Tomographic Angiography Kembu Nakamoto, MD, PhD, Ken-ichi Omori, MD, PhD, Kenji Nezu, MD, PhD The Annals of Thoracic Surgery Volume 89, Issue 3, Pages 877-883 (March 2010) DOI: 10.1016/j.athoracsur.2009.11.037 Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) Peripheral segments reproduced from the consensus arrangement produced by the Japanese Committee on the Nomenclature for Bronchial Branching (solid line = intersegment plane; fine solid line = inter-subsegment plane; broken line = interdaughter segment plane; S1 to S10 = segments; a, b, c = subsegments; i, ii = daughter segments). The right S7 is deleted. (B) Nodule locations. (Open circle, open square, and triangle = ground glass opacity nodules less than 10 mm, 10 to 20 mm, and 20 mm∼, respectively. Closed circle and square = solid nodules less than 10 mm and 10 to 20 mm, respectively.) The Annals of Thoracic Surgery 2010 89, 877-883DOI: (10.1016/j.athoracsur.2009.11.037) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Diagram of diagnosis and treatment process. (AAH = atypical adenomatous hyperplasia; Ad = adenocarcinoma; BAC = bronchioloalveolar carcinoma; compromised = compromised condition with major comorbidities; CT = computed tomography; GGO = ground glass opacity; LC = lung cancer; meta = metastatic tumor; N0,1 = lymph node status; SSS = superselective segmentectomy; () = number of patients.) The Annals of Thoracic Surgery 2010 89, 877-883DOI: (10.1016/j.athoracsur.2009.11.037) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 (A) A tiny pulmonary nodule that showed ground glass opacity on computed tomography (CT). (B) A three-dimensional (3D)-CT angiography of the topographic relationship between the nodule and the target arteries in a single patient who underwent a combination daughter segmentectomy of S1aii and S2ai. (C) A ground glass opacity nodule on CT. (D) A 3D-CT angiography of the topographic relationship between the nodule and the target arteries. The target arteries A3b and A3c shared a common parent artery with A3a (recurrent type), and the patient underwent bi-subsegmentectomy of S3b and S3c. This branching pattern allowed mediastinal access for the surgical procedure. The Annals of Thoracic Surgery 2010 89, 877-883DOI: (10.1016/j.athoracsur.2009.11.037) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Postoperative lung function. Actual forced expiratory volume in one second after superselective segmentectomy (actFEV1) was well preserved as predicted before the operation (prdFEV1). (Solid line = actFEV1(L) = 0.925 × prdFEV1(L) −0.015 R2 = 0.924, p < 0.0001; broken line represents actFEV1 = prdFEV1.) The Annals of Thoracic Surgery 2010 89, 877-883DOI: (10.1016/j.athoracsur.2009.11.037) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions