Oracoscopic Surgical Treatment Of Simultaneous Multiple Primary Lung Cancer Based On 3D Reconstruction

Objective(s):In recent years,lung cancer has had the highest prevalence rate of all malignant tumours,and its morbidity and mortality have been growing annually.As a form of rare lung disease,multiple primary lung cancer(MPLC)also exhibited an upward trend over time.In recent years,the detection rate of MPLC has increased significantly due to the widespread use of low-dose spiral computed tomography(LDCT)and the rising need for physical examination.This study investigated the value of the three-dimensional(3D)reconstruction technique in 46 cases of simultaneous multiple primary lung cancer(s MPLC)patients enrolled in clinical research.Methods:Between January 2020 and December 2022,a retrospective study was conducted on the basis of 46 MPLC patients in The Second Affiliated Hospital of Kunming Medical University from January 2020 to January 2022.And in the preoperative software Mimics Medical 21.0 from the Belgium Materialise Company,the anatomy of lung tissue is reconstructed and the relationship between nodal positions is figured out.Each group had three-dimensional reconstruction or CT-guided hook-wire puncture localization of a pulmonary ground glass nodule.Using the results of the three-dimensional reconstruction,a thoracoscopic lobectomy or sublobectomy was conducted following the completion of localization.After removing the specimen,the distances between the ground-glass nodule(GGN)and the suture mark,as well as the distance between the GGN and the incisal edge of the specimen,were measured.The specimens of the incisal edge were then submitted for a quick frozen section to ensure an acceptable range of the incisal edge.To investigate the application value of 3D reconstruction technology for thoracoscopic surgery with s MPLC and to perform a statistical analysis of the success rate of nodule localization to serve as a reference for clinical treatment and prognosis.Excel 2003 was used to collect and record all the data for this study,which was then imported into SPSS 25.0(IBM)for calculation and analysis.The mean and ± standard deviation were used to describe quantitative data conforming to a normal distribution,utilization rate or component ratio was used to represent count data,and the inter-group T-test or Chi-square test was used for verification.When P is less than 0.05,the difference was considered statistically significant.Results:Using 3D reconstruction localization and CT-guided hook-wire pulmonary grinding glass nodule puncture 3 localization,46 patients with s MPLC were separated into an experimental group and a control group for retrospective analysis.There were 4 males(15.4%)and 22 females(84.6%)in the experimental group,with an average age of 57.65±12.00 years.Four patients(15.4 percent)had a smoking history.After 3D reconstruction,57 nodules were removed,including 14nodules(20.2%)in the upper lobe of the right lung,6 nodules(10.5%)in the middle lobe of the right lung,15 nodules(26.3%)in the lower lobe of the right lung,8nodules(14.0%)in the upper lobe of the left lung,and 12 nodules(21.1%)in the lower lobe of the left lung.Cuneiform resection was performed 30 times(68.2%),segmental resection 10 times(22.7%),and lobectomy 4 times(9.1%).In the control group,there were 12 males(60.0%)and 8 females(40.0%),with an average age of59.25 ± 9.59 years.Six patients(30.0%)had a smoking history.40 nodules were located through CT-guided hook-wire pulmonary ground glass nodule puncture,including 6 nodules in the upper lobe of the right lung(15.0%),5 nodules in the middle lobe of the right lung(12.5%),10 nodules in the lower lobe of the right lung(25.0%),8 nodules in the upper lobe of the left lung(20.0%),and 11 nodules in the lower lobe of the left lung(27.5%).Cuneiform resection was performed 11 times(33.3%),segmental resection 7 times(21.2%)and lobectomy 15 times(45.5%).When the location was less than 2cm from the nodule,the accuracy of nodule positioning in the experimental group reached 92.98%,and the positioning time for a single nodule was(8.5±3.7)minutes.In the control group,the localization accuracy of nodules was92.5%,and the localization time for a single nodule was(6.5 ± 3.8)minutes.Pathological results: In the experimental group,there were 57 nodules,14 of which were atypical adenomatous hyperplasia(24.5%),9 of which were carcinoma in situ(15.8%),22 of which were microinvasive adenocarcinomas(38.6%),and 12 of which were invasive adenocarcinomas(21.1%).In the control group,there were 40 nodules,9 cases of atypical adenomatous hyperplasia(22.5%),4 cases of carcinoma in situ(10.0%),6 cases of microinvasive adenocarcinoma(15.0%),20 cases of invasive adenocarcinoma(50.0%),and 1 case of squamous carcinoma(2.5%).No recurrences or distant metastases occurred during the average 10-month follow-up of these patients.In the experimental group,the average intraoperative blood loss was(130.19±128.98)ml,the average postoperative catheterization time was(4.73±2.76)days,the average postoperative drainage volume was(856.15 ± 540.09)ml,the average postoperative hospital stay was(6.50 ± 2.84)days,and there was one postoperative complication(3.8%).In the control group,the average intraoperative blood loss was(307.50±388.07)ml,the average postoperative catheterization time was(5.95±2.80)days,the average postoperative drainage volume was(1234.5 ±905.29)ml,the average postoperative hospital stay was(7.80±2.96)days,and there were 3 postoperative complications(15%).Conclusion(s):Using 3D reconstruction technology,the planar anatomical relationship between pulmonary nodules,arteriovenous,bronchus,and segments may be shown more clearly.This technique is not only conducive to accurate positioning of nodules during surgery,but also provides effective assistance for the selection of surgical methods for multiple nodules of adjacent lung segments in s MPLC patients,so as to minimize the loss of lung function of patients,and is of great importance for the personalized formulation of surgical protocols and the planning of surgical incisal margins.Simultaneously,it can eliminate the risk and hazards of preoperative invasive puncture localization and reduce the time required for an intraoperative GGNS search.These findings contribute to the acceleration of perioperative recovery and the reduction of postoperative catheterization time and hospital stay.