Surgical outcomes of anatomical sublobar resections of left upper lobe and a technique of subsegmentectomy based on bronchovascular patterns.

Background: Anatomical sublobar resection was widely performed for small-sized nodule located in the deep field of the lung. In this study, we compared surgical outcomes between anatomical sublobar resection in left upper lobe including segmentectomy and subsegmentectomy. We also applied a technique based on bronchovascular patterns for subsegmentectomy.

Patients And Methods: A hundred and fifty-one patients underwent anatomical sublobar resection of left upper lobe in our hospital in the period from January 2018 to December 2019 and they were retrospectively reviewed. Patients' characteristics and surgical outcome of the subsegmentectomy group (n = 71) were analyzed and compared to those of patients of the segmentectomy group (n = 80). The bronchovascular patterns of left upper lobe in these patients were also classified, and a technique of subsegmentectomy was introduced by cases description.

Results: Compared to segmentectomy, the subsegmentectomy group had longer operative time [141min, interquartile range (IQR): 125-161 vs. 127.5 min, interquartile range (IQR): 114.75-148.25; P = 0.001] and more estimated blood loss [50 mL, IQR: 30-50 vs. 30 mL, IQR: 20-50; P = 0.02]. Branching pattern of bronchus was classified into 3 types in left upper division, and 2 types in lingular division. Branching pattern of pulmonary artery was classified into 7 types in left upper division and 2 types in lingular division. Branching pattern of pulmonary vein was classified into 3 types in left upper division and V b was classified into 4 types.

Conclusion: Subsegmentectomy is a safe procedure with surgical outcome comparable to the one of segmentectomy except operative time and estimated blood loss. Subsegmentectomy based on bronchovascular patterns in left upper lobe is feasible.