Preoperative CT–derived 3D modeling for planning sublobar lung resections in children with benign lesions.

S Vydysh¹, O Topilin², O Pikin³, A Chukanova⁴, Y Sokolov⁵

¹Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation.
²Russian Children's Clinical Hospital, a branch of Pirogov Russian National Research Medical University, Moscow, Russian Federation.
³Herzen Research Oncological Institute, Moscow, Russian Federation
⁴I.M.Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation.
⁵Morozovskaya Children's City Clinical Hospital, Moscow, Russian Federation.

Purpose
Congenital lung malformations (CLMs) and benign tumors in children often involve one or few segments. Nevertheless, wedge resection or lobectomy are performed, while anatomical segmentectomy remains rare due to lack of clear indications. This study aims to evaluate how preoperative three-dimensional (3D) lung modeling influences planning and execution of surgery for benign lung lesions in children.

Method
Retrospective review of 32 patients (1–17 years) undergoing lung resection between January 2020 and June 2025 for CLMs or benign lesions. Exclusions: bullous disease, infectious or malignant lung pathology. 3D group (n = 16; mean age 11.1 years): preoperative segmentation and modeling of vessels, bronchi, and lesion margins in 3D Slicer. Control group (n = 16; mean age 6.9 years): planning using 2D contrast–enhanced computed tomography (CT).
Statistical tests: χ² or Fisher’s exact for categorical variables, Mann–Whitney U for continuous variables, and stepwise linear and logistic regression; p ≤ 0.05.

Results
Sublobar surgery occurred in 100 % of 3D group (37.5 % wedge, 62.5 % segmentectomy) versus 37.6 % in control (18.8 % wedge, 18.8 % segmentectomy) with 68.8 % lobectomies (p < 0.001). Operation time: 140 [95–230] min versus 130 [101,25–157,5] min (p > 0.05). Intraoperative complications: 12.5 % vs. 6.3 % (р>0,05); early postoperative: 18.8 % vs. 25.0 % (р>0,05). Chest drainage: 5.5 [4–7.8] vs. 6.5 [5–14.3] days (р>0,05); hospital stay: 7 [6–9] vs. 8 [7–16.5] days (р>0,05). Predictors of resection volume were age (β = –0.006 ml/mo), lesion type (β = –0.688), and number of involved segments (β = 0.255); all p < 0.01.

Conclusion
Preoperative CT-derived 3D modeling in children with benign pulmonary lesions increases the rate of sublobar resections without extending operative time or elevating complication rates, most likely due to enhanced lesion localization and more precise indication selection.

Keywords: Sublobar lung resection, Anatomical segmentectomy, Congenital lung malformations, Computed tomography–derived 3D modeling, Lung sparing surgery, Surgical planning

S Vydysh¹, O Topilin², O Pikin³, A Chukanova⁴, Y Sokolov⁵

¹Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation.
²Russian Children's Clinical Hospital, a branch of Pirogov Russian National Research Medical University, Moscow, Russian Federation.
³Herzen Research Oncological Institute, Moscow, Russian Federation
⁴I.M.Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation.
⁵Morozovskaya Children's City Clinical Hospital, Moscow, Russian Federation.

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