Inter-multisegmental veins (IMSVs): a new positional indication for pulmonary segmentectomy

Highlight box

Key findings

• Inter-multisegmental veins (IMSVs) exhibited high prevalences in our study, with the lateral vein (Vl) demonstrating diverse drainage patterns, contrasting with the minimal variation observed in the branches of the superior segmental vein (V⁶b). The depth ratio and the lesion’s relative position to the IMSVs were identified as critical factors for determining the longitudinal and transverse positional indications, respectively, for sublobar resection in patients with clinical T1a–bN0 non-small cell lung cancer (NSCLC).

What is known and what is new?

• Traditional indications for sublobar resection focus primarily on the radiological characteristics of the lesion while positional indications associated with IMSVs remain underreported and warrant further investigation.

• Positional indicators, such as depth ratio and the lesion’s relative location to the IMSVs, along with traditional indications such as diameter and consolidation-to-tumour ratio, were identified critical for sublobar resection in patients with clinical T1a–bN0 NSCLC.

What is the implication, and what should change now?

• It is crucial to emphasize the spatial location of lesions, including their longitudinal depth and proximity to transverse adjacent structures, including IMSVs, in achieving successful anatomical sublobar resection, ensuring safe margins, and maintaining surgical quality control.

Publication: Bian C, Fu C, Wang Y, Huang J, Yuan M, Chen L, Wang Q, Wang J. Inter-multisegmental veins (IMSVs): a new positional indication for pulmonary segmentectomy. J Thorac Dis 2025;17(2):603-613. doi: 10.21037/jtd-24-1799