A new classification of left apicoposterior segmental bronchus and its clinical significance_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Jian , WEI Li , ZHU Li , HU Shuai , XIA Tian ,  WEI Wenxue

Department of Thoracic Surgery, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, 450066,P. R. China;

Corresponding author：

WEI Wenxue, Email: shengyixiongwai@163.com

Keywords：

Apicoposterior bronchus; anatomical classification; surgical operation

DOI：

10.7507/1007-4848.202203017

Video：

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Objective To analyze a new classification of the left apicoposterior segmental bronchus and summarize its clinical significance. Methods We accessed the computed tomography imaging data of the inpatients treated in the Department of Thoracic Surgery, Henan Provincial People's Hospital between January and November 2021. We observed and classified the branching pattern of the left apicoposterior segmental bronchus (B¹⁺²) using three-dimensional computed tomography bronchography and angiography (3D-CTBA) technique. And we filtered out the patients who underwent thoracoscopic left apicoposterior segmentectomy and analyzed their clinical data retrospectively to summarize the instructing significance of different bronchial classification in the accurate and safe operation of left apicoposterior segmentectomy. Results Finally 240 patients were collected, including 131 males and 109 females with a median age of 51.0 (19.0-77.0) years. The anatomical pattern of the left apicoposterior segmental bronchus was divided into four main types based on the branching pattern of the outer subsegmental bronchi (B¹⁺²c): type Ⅰ 10% (24 patients), type Ⅱ 54% (130 patients) , type Ⅲ 17% (40 patients) , type Ⅳ 18% (43 patients) and other variations 1% (3 patients). Thirty-two patients smoothly underwent thoracoscopic left apicoposterior segmentectomy, including 23 patients of type Ⅰ and type Ⅱ receiving LS¹⁺² resection, the other 9 patients of type Ⅲ and type Ⅳ receiving LS¹⁺² resection (3 patients), LS¹⁺²c resection (4 patients) and LS¹⁺²(a+b) resection (2 patients). Conclusion This new classification systematically and concisely elucidates the branching characteristics of the left apicoposterior bronchus. Different branching types are instructive to the left apicoposterior segmentectomy.

Citation： LIU Jian, WEI Li, ZHU Li, HU Shuai, XIA Tian, WEI Wenxue. A new classification of left apicoposterior segmental bronchus and its clinical significance. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(1): 92-98. doi: 10.7507/1007-4848.202203017 Copy

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3.	Suzuki K, Saji H, Aokage K, et al. Comparison of pulmonary segmentectomy and lobectomy: Safety results of a randomized trial. J Thorac Cardiovasc Surg, 2019, 158(3): 895-907.
4.	Zhang M, Liu D, Wu W, et al. Preoperative 3D-CT bronchography and angiography facilitates single-direction uniportal thoracoscopic anatomic lobectomy. Ann Transl Med, 2019, 7(20): 526.
5.	钟世镇, 何光篪, 陈尔瑜, 等. 中国人肺的支气管和血管四、左肺上叶的支气管和血管. 解剖学报, 1963, 6(2): 183-199.
6.	Boyden EA. A synthesis of the prevailing patterns of the bronchopulmonary segments in the light of their variations. Dis Chest, 1949, 15(6): 657-668.
7.	Boyden EA, Hartmann JF. An analysis of variations in the bronchopulmonary segments of the left upper lobes of fifty lungs. Am J Anat, 1946, 79: 321-360.
8.	Lee KS, Bae WK, Lee BH, et al. Bronchovascular anatomy of the upper lobes: Evaluation with thin-section CT. Radiology, 1991, 181(3): 765-772.
9.	Zhao X, Ju Y, Liu C, et al. Bronchial anatomy of left lung: A study of multi-detector row CT. Surg Radiol Anat, 2009, 31(2): 85-91.
10.	Maki R, Miyajima M, Ogura K, et al. Pulmonary vessels and bronchus anatomy of the left upper lobe. Surg Today, 2022, 52(4): 550-558.
11.	Nomori H, Shiraishi A, Yamazaki I, et al. Extent of segmentectomy that achieves greater lung preservation than lobectomy. Ann Thorac Surg, 2021, 112(4): 1127-1133.
12.	NCCN. NCCN clinical practice guidelines in oncology: Non-small cell lung cancer (version 1.2020). URL: https://www.nccn.org/.
13.	Martín-Ruiz S, Gutiérrez-Collar C, Forcén Vicente De Vera E, et al. The bronchial segmentation and its anatomical variations. A clinical-anatomic and bronchoscopy study. Ann Anat, 2021, 235: 151677.
14.	Isaka T, Mitsuboshi S, Maeda H, et al. Anatomical analysis of the left upper lobe of lung on three-dimensional images with focusing the branching pattern of the subsegmental veins. J Cardiothorac Surg, 2020, 15(1): 273.
15.	Zhu XY, Yao FR, Xu C, et al. Utility of preoperative three-dimensional CT bronchography and angiography in uniportal video-assisted thoracoscopic anatomical lobectomy: A retrospective propensity score-matched analysis. Ann Transl Med, 2021, 9(6): 480.

1. 黄晓锋, 虞桂平, 糜烨东, 等. 胸腔镜肺叶切除术与肺段切除术治疗T1bN0M0期非小细胞肺癌的回顾性队列研究. 中国胸心血管外科临床杂志, 2022, 29(10): 1296-1302.
2. Cao J, Yuan P, Wang Y, et al. Survival rates after lobectomy, segmentectomy, and wedge resection for non-small cell lung cancer. Ann Thorac Surg, 2018, 105(5): 1483-1491.
3. Suzuki K, Saji H, Aokage K, et al. Comparison of pulmonary segmentectomy and lobectomy: Safety results of a randomized trial. J Thorac Cardiovasc Surg, 2019, 158(3): 895-907.
4. Zhang M, Liu D, Wu W, et al. Preoperative 3D-CT bronchography and angiography facilitates single-direction uniportal thoracoscopic anatomic lobectomy. Ann Transl Med, 2019, 7(20): 526.
5. 钟世镇, 何光篪, 陈尔瑜, 等. 中国人肺的支气管和血管四、左肺上叶的支气管和血管. 解剖学报, 1963, 6(2): 183-199.
6. Boyden EA. A synthesis of the prevailing patterns of the bronchopulmonary segments in the light of their variations. Dis Chest, 1949, 15(6): 657-668.
7. Boyden EA, Hartmann JF. An analysis of variations in the bronchopulmonary segments of the left upper lobes of fifty lungs. Am J Anat, 1946, 79: 321-360.
8. Lee KS, Bae WK, Lee BH, et al. Bronchovascular anatomy of the upper lobes: Evaluation with thin-section CT. Radiology, 1991, 181(3): 765-772.
9. Zhao X, Ju Y, Liu C, et al. Bronchial anatomy of left lung: A study of multi-detector row CT. Surg Radiol Anat, 2009, 31(2): 85-91.
10. Maki R, Miyajima M, Ogura K, et al. Pulmonary vessels and bronchus anatomy of the left upper lobe. Surg Today, 2022, 52(4): 550-558.
11. Nomori H, Shiraishi A, Yamazaki I, et al. Extent of segmentectomy that achieves greater lung preservation than lobectomy. Ann Thorac Surg, 2021, 112(4): 1127-1133.
12. NCCN. NCCN clinical practice guidelines in oncology: Non-small cell lung cancer (version 1.2020). URL: https://www.nccn.org/.
13. Martín-Ruiz S, Gutiérrez-Collar C, Forcén Vicente De Vera E, et al. The bronchial segmentation and its anatomical variations. A clinical-anatomic and bronchoscopy study. Ann Anat, 2021, 235: 151677.
14. Isaka T, Mitsuboshi S, Maeda H, et al. Anatomical analysis of the left upper lobe of lung on three-dimensional images with focusing the branching pattern of the subsegmental veins. J Cardiothorac Surg, 2020, 15(1): 273.
15. Zhu XY, Yao FR, Xu C, et al. Utility of preoperative three-dimensional CT bronchography and angiography in uniportal video-assisted thoracoscopic anatomical lobectomy: A retrospective propensity score-matched analysis. Ann Transl Med, 2021, 9(6): 480.

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A new classification of left apicoposterior segmental bronchus and its clinical significance

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