Abstract
BACKGROUND: To investigate the distribution pattern of V(1+2) d in the left superior pulmonary vein and its clinical significance. METHODS: A retrospective analysis was conducted using three-dimensional computed tomographic bronchography and angiography (3D-CTBA) data from 500 lung cancer patients. Statistical analyses were performed to evaluate the incidence and drainage patterns of the three sub-branches of V(1+2) d, namely V(1+2) d1, V(1+2) d2 and V(1+2) d3. Furthermore, clinical data from 10 patients' lesions involving V(1+2) d were reviewed to illustrate the impact of adjacency to V(1+2) d on the surgical approach. RESULTS: The incidences of V(1+2) d1, V(1+2) d2 and V(1+2) d3 were 100%, 76.4% and 100% respectively. The relative interlobar distribution sizes of B(3) a and B(1+2) c and the left upper division (LUD) vein type influenced the incidence of V(1+2) d2 (p < 0.05; p < 0.001). V(1+2) d2 predominantly occurred in B(3) a = B(1+2) c and B(1+2) c > B(3) a patterns. V(1+2) d2 was entirely absent in the B(3) a > B(1+2) c pattern. V(1+2) d2 exhibited a higher incidence in both the central vein (CV) type and the noncentral vein (NCV) type when compared to the semi-central vein (SCV) type (100% vs. 100% vs. 64.8%). The most prevalent venous drainage pattern was the three sub-branches of V(1+2) d constituting a major trunk to drain (41.2%). All 10 cases with lesions involving V(1+2) d successfully underwent sublobar resection with no complications, and the surgical margin was ≥2 cm. CONCLUSIONS: The three sub-branches of V(1+2) d exhibit a high incidence with diverse distribution patterns, yet a discernible pattern exists. For inter- or multi-intersegmental nodules involving V(1+2) d, combined segmentectomy and subsegmentectomy or combined subsegmentectomy can ensure the safe margin.