Surgical strategies for SMPLC present challenges. Each nodule’s position and size differ; therefore, an individualized approach for the design of a surgical strategy for each patient with SMPLC is required. When the main lesion is removed, if surgical resection does not seriously affect pulmonary function, as many of the nodules in the same lobe or other lobes as possible are also surgically removed . Therefore, it is very important to design an optimized surgical strategy prior to the operation. Herein, we provide a typical clinical example to demonstrate the preoperative planning procedure for the use of 3D-CTLR to reconstruct lobes containing nodules, virtual simulation, and intraoperative guidance of VATS resection.
Surgical procedures for SMPLC are determined according to tumor size and location and cardiopulmonary function . As pneumonectomy is associated with a high risk of postoperative respiratory failure and should be avoided whenever possible, sublobar resection for the first tumor, including wedge resection and segmentectomy under VATS, remains a good alternative; this is especially true for bilateral tumors, which usually require the sacrifice of less lung to preserve the feasibility and safety of contralateral resection . There were four nodules in the right upper lobe of our patient. Without 3D-CTLR, our surgical plan may have included right upper lobectomy or apical posterior segmentectomy. We analyzed the relative positions of these nodules according to a 3D model, and we then chose sublobar resection, that is, apical segmentectomy with wedge resection of the posterior segment. This surgical strategy preserved the anterior segment and most of the posterior segment of the right upper lobe, which avoided right upper pneumonectomy. Therefore, we believe that the use of 3D-CTLR to plan the surgery, while ensuring nodular resection, can preserve lung tissue as much as possible. The latter is particularly important for patients with SMPLC. Of course, there are many factors and issues that need to be discussed, but through these this case, we wish to convey that for patients with SMPLC, preoperative 3D-CTLR can help us design a surgical strategy, that is, the extent and method of resection.