Classification of trans-subsegmental artery in the right upper lobe: A retrospective study in a single center_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XU Xinfeng , WEN Wei , ZHU Quan ,  CHEN Liang

Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, P. R. China;

Corresponding author：

CHEN Liang, Email: clbright0909@njmu.edu.cn

Keywords：

Subsegmental artery; bronchial typing; trans-subsegmental artery; margin

DOI：

10.7507/1007-4848.202306030

Video：

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Objective To improve the precision of subsegmentectomy, through analyzing the proportion and classification of the intrasegmental and intersegmental trans-subsegmental artery (TSA) in the right upper lobe. Methods The imaging data of the patients who underwent pulmonary angiography in the right upper lobe from January 2021 to June 2022 at the Department of Thoracic Surgery, the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed. The anatomy of subsegmental bronchi and arteries in the right upper lung was studied by comparing 3D CT bronchography and angiography and thin-section CT (lung window). The types of tans-subsegmental artery were further refined. Results Finally 111 patients were collected, including 36 males and 75 females with an average age of 61.83±8.91 years. There were 29 types of TSA in the right upper pulmonary artery, and 45% (13/29) of the types occurred only once. In the S¹, S², and S³ segments, the proportion of TSA was 52% (58/111), 41% (45/111), and 32% (36/111), respectively. Among them, the type with the highest proportion was A¹b+A¹at in S¹, originating from the upper trunk artery, accounting for 67% (39/58). There were 24% (27/111), 5% (5/111), and 8% (9/111) TSA between S¹ and S², S² and S³, and S¹ and S³, respectively. There were four types of bronchi in the right upper lobe. There was no statistical difference in the proportion of the intrasegmental and intersegmental TSA (P>0.05). Conclusion The TSA in the right upper lobe is common and has various types. Segmentectomy or subsegmentectomy is a highly personalized surgical procedure.

Citation： XU Xinfeng, WEN Wei, ZHU Quan, CHEN Liang. Classification of trans-subsegmental artery in the right upper lobe: A retrospective study in a single center. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(12): 1737-1742. doi: 10.7507/1007-4848.202306030 Copy

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32.	El-Sherif A, Fernando HC, Santos R, et al. Margin and local recurrence after sublobar resection of non-small cell lung cancer. Ann Surg Oncol, 2007, 14(8): 2400-2405.

1. National Lung Screening Trial Research Team, Aberle DR, Adams AM, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med, 2011, 365(5): 395-409.
2. Zhang Y, Jheon S, Li H, et al. Results of low-dose computed tomography as a regular health examination among Chinese hospital employees. J Thorac Cardiovasc Surg, 2020, 160(3): 824-831.
3. Kakinuma R, Noguchi M, Ashizawa K, et al. Natural history of pulmonary subsolid nodules: A prospective multicenter study. J Thorac Oncol, 2016, 11(7): 1012-1028.
4. Suzuki K, Watanabe S, Wakabayashi M, et al. A nonrandomized confirmatory phase Ⅲ study of sublobar surgical resection for peripheral ground glass opacity dominant lung cancer defined with thoracic thin-section computed tomography (JCOG0804/WJOG4507L). J Clin Oncol, 2017, 35(15_suppl): 8561.
5. Aokage K, Yoshida J, Hishida T, et al. Limited resection for early-stage non-small cell lung cancer as function-preserving radical surgery: A review. Jpn J Clin Oncol, 2017, 47(1): 7-11.
6. Takamori S, Oizumi H, Suzuki J, et al. Video-assisted thoracoscopic segmentectomy for deep and peripheral small lung cancer. Thorac Cardiovasc Surg, 2022, 70(3): 233-238.
7. Wu L, Zhao W, Chen T, et al. Surgical choice for patients with stage Ⅰ non-small-cell lung cancer ≤2 cm: An analysis from surveillance, epidemiology, and end results database. J Cardiothorac Surg, 2021, 16(1): 191.
8. Saji H, Okada M, Tsuboi M, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): A multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet, 2022, 399(10335): 1607-1617.
9. Yoshimoto K, Nomori H, Mori T, et al. Combined subsegmentectomy: Postoperative pulmonary function compared to multiple segmental resection. J Cardiothorac Surg, 2011, 6: 17.
10. Nomori H, Cong Y, Sugimura H. Systemic and regional pulmonary function after segmentectomy. J Thorac Cardiovasc Surg, 2016, 152(3): 747-753.
11. Handa Y, Tsutani Y, Mimae T, et al. Oncologic outcomes of complex segmentectomy: A multicenter propensity score-matched analysis. Ann Thorac Surg, 2021, 111(3): 1044-1051.
12. Nakamoto K, Omori K, Nezu K, et al. Superselective segmentectomy for deep and small pulmonary nodules under the guidance of three-dimensional reconstructed computed tomographic angiography. Ann Thorac Surg, 2010, 89(3): 877-883.
13. Matsui T, Takahashi Y, Shirai S, et al. Comparison of surgical outcomes between thoracoscopic anatomical sublobar resection including and excluding subsegmentectomy. Gen Thorac Cardiovasc Surg, 2021, 69(5): 850-858.
14. Kuroda H, Sakata S, Takahashi Y, et al. Subsegmental resection preserves regional pulmonary function: A focus on thoracoscopy. Thorac Cancer, 2021, 12(7): 1033-1040.
15. Sato M, Murayama T, Nakajima J. Concepts and techniques: How to determine and identify the appropriate target segment in anatomical pulmonary segmentectomy? J Thorac Dis, 2019, 11(3): 972-986.
16. Misaki N, Chang SS, Igai H, et al. New clinically applicable method for visualizing adjacent lung segments using an infrared thoracoscopy system. J Thorac Cardiovasc Surg, 2010, 140(4): 752-756.
17. Yao F, Wu W, Zhu Q, et al. Thoracoscopic pulmonary segmentectomy with collateral ventilation method. Ann Thorac Surg, 2021, 112(6): 1814-1823.
18. Bédat B, Triponez F, Sadowski SM, et al. Impact of near-infrared angiography on the quality of anatomical resection during video-assisted thoracic surgery segmentectomy. J Thorac Dis, 2018, 10(Suppl 10): S1229-S1234.
19. Xu XF, Chen L, Wen W, et al. Thoracoscopic pulmonary combined with right S1a+S2a subsegmentectomy for deep intersegmental nodule surgery. J Vis Surg, 2018, 4(7): 131.
20. Oho K, Ryuta A. Chief editor. Practical Fiberoptic Bronchoscopy. 1st ed. Tokyo: Igaku-Shoin, 1980. 26.
21. Nagashima T, Shimizu K, Ohtaki Y, et al. An analysis of variations in the bronchovascular pattern of the right upper lobe using three-dimensional CT angiography and bronchography. Gen Thorac Cardiovasc Surg, 2015, 63(6): 354-360.
22. Zhang M, Mao N, Wang SH, et al. The B1 defective type of bifurcated right upper lobe bronchus. J Thorac Dis, 2019, 11(10): 4218-4223.
23. Boyden EA. Chief editor. Segmental Anatomy of the Lungs: A Study of the Patterns of the Segmental Bronchi and Related Pulmonary Vessels. New York: Blakiston Division, McGraw-Hill, 1955. 56.
24. Yamashita H. Chief editor. Roentgenologic Anatomy of the Lung. Tokyo: Igaku-Shoin, 1978. 79.
25. Kato H, Oizumi H, Suzuki J, et al. Roles and outcomes of thoracoscopic anatomic lung subsegmentectomy for lung cancer. Interact Cardiovasc Thorac Surg, 2022, 34(1): 81-90.
26. Chang CC, Yen YT, Lin CY, et al. Single-port video-assisted thoracoscopic surgery subsegmentectomy: The learning curve and initial outcome. Asian J Surg, 2020, 43(5): 625-632.
27. Wu WB, Xia Y, Pan XL, et al. Three-dimensional navigation-guided thoracoscopic combined subsegmentectomy for intersegmental pulmonary nodules. Thorac Cancer, 2019, 10(1): 41-46.
28. Mohiuddin K, Haneuse S, Sofer T, et al. Relationship between margin distance and local recurrence among patients undergoing wedge resection for small (≤2 cm) non-small cell lung cancer. J Thorac Cardiovasc Surg, 2014, 147(4): 1169-1175.
29. Takahashi N, Sawabata N, Kawamura M, et al. Optimal sublobar resection for c-stage Ⅰ non-small cell lung cancer: Significance of margin distance to tumor size ratio and margin cytology (Supplementary analysis of KLSG-0801): Complete republication. Gen Thorac Cardiovasc Surg, 2019, 67(8): 690-696.
30. Yin P, Yue B, Zhang J, et al. Optimal margins for early stage peripheral lung adenocarcinoma resection. BMC Cancer, 2021, 21(1): 533.
31. Nishio W, Yoshimura M, Maniwa Y, et al. Re-assessment of intentional extended segmentectomy for clinical T1aN0 non-small cell lung cancer. Ann Thorac Surg, 2016, 102(5): 1702-1710.
32. El-Sherif A, Fernando HC, Santos R, et al. Margin and local recurrence after sublobar resection of non-small cell lung cancer. Ann Surg Oncol, 2007, 14(8): 2400-2405.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Classification of trans-subsegmental artery in the right upper lobe: A retrospective study in a single center

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