Impact of patient-specific three-dimensional reconstruction on surgical planning and perioperative outcomes in early-stage lung cancer: a randomised clinical trial.

BACKGROUND: Anatomical segmentectomy requires precise identification of the segmental bronchi and vessels; however, conventional two-dimensional (2D) CT provides limited visualisation of their three-dimensional (3D) anatomical relationships and variations. METHODS: In this prospective randomised controlled trial, patients with early-stage non-small cell lung cancer (NSCLC) who were scheduled to undergo uniportal thoracoscopic anatomical segmentectomy were assigned to either the 2D CT group or the 3D reconstruction group. The trial was registered with the Chinese Clinical Trial Registry before patient enrolment (ChiCTR2500104962; registered 26 June 2025). The primary outcome was key-phase operative time, defined as the interval from the start of segmental hilar dissection to completion of segmentectomy. Total operative time, defined as the interval from skin incision to closure, was assessed as an additional time-based outcome. Secondary outcomes included intraoperative unexpected events, attainment of adequate pathological margins, and surgeon-reported experience. Prespecified subgroup analyses were conducted according to surgeon seniority and segmentectomy complexity. Surgeon-reported experience was assessed using structured questionnaires. RESULTS: A total of 144 patients were included. Compared with the 2D CT group, the 3D group demonstrated markedly reduced key-phase operative time (75.78 ± 24.44 min vs 95.74 ± 31.43, P < 0.001), fewer intraoperative unexpected events (6.9% vs 30.6%, P = 0.001), and a higher rate of achieving safe surgical margins (84.7% vs 66.7%, P = 0.016). No statistically significant differences were observed in total operative time, postoperative complications, or other perioperative outcomes between the two groups (P > 0.05). In contrast, surgeons in the 3D group reported superior preoperative anatomical visualization, enhanced intraoperative confidence, and reduced perceived stress levels (all P < 0.001). Notably, the reduction in key-phase operative time was more prominent among surgeons with less clinical experience (P = 0.018). CONCLUSION: Preoperative 3D reconstruction shortened key-phase operative time, reduced intraoperative unexpected events, improved pathological margin attainment, and was associated with more favourable surgeon-reported experience.