Pulmonary function changes after sublobar resection in patients with peripheral non-subpleural nodules

Abstract

Background In the treatment of peripheral early-staged lung cancer and benign lesions, segmentectomy and wedge resection are both reliable treatment methods. It is debatable that how much pulmonary function will be lost after different sublobar resection in the treatment of early-staged deep-located peripheral NSCLC (non-small cell lung cancer). The purpose of this study was to explore postoperative pulmonary function changes of sublobar resection in enrolled patients with non-subpleural peripheral nodules. Methods We collected clinical data of patients undergoing VATS (video-assisted thoracoscopic surgery) segmentectomy or wedge resection for single nodule. These nodules were confirmed as peripheral non-subpleural nodules by preoperative 3D imaging. Patients were divided into two groups according to the operation procedure. Demographic characteristics, pulmonary function, postoperative outcomes, and others were collected. All data was gathered at the First Affiliated Hospital of Soochow University. Outcomes after wedge resection were compared with those after segmentectomy resection. Results A total of 88 patients were included in this study, including 46 patients with VATS wedge resection and 42 patients with VATS segmentectomy. No difference was detected when comparing FEV1 (forced expiratory volume in 1 s) loss between these two groups (17.6 ± 2.1%, wedge resection vs. 19.4 ± 5.4%, segmentectomy, P = 0.176). FVC (forced vital capacity) loss (8.7 ± 2.3%, wedge resection vs. 17.1 ± 2.2%, segmentectomy, P < 0.001) and MVV (maximum ventilatory volume) loss (11.5 ± 3.1%, wedge resection vs. 20.6 ± 7.8%, segmentectomy, P < 0.001) in segmentectomy group was significantly higher than those in wedge resection group. Discrepancies were investigated when comparing duration of surgery (70 ± 22 min, wedge resection vs. 111 ± 52 min, segmentectomy, P = 0.0002), postoperative drainage (85 ± 45 mL, wedge resection vs. 287 ± 672 mL, segmentectomy, P = 0.0123), and treatment hospitalization expenses [35148 ± 889CNY, wedge resection vs. 52,502 (38,276–57,772) CNY, segmentectomy, P < 0.0002]. No significant difference was found between air leak time (1.7 ± 0.7 days, wedge resection vs. 2.5 ± 1.7 days, segmentectomy, P = 0.062) and hospitalization time (2.7 ± 0.7 days, wedge resection vs. 3.5 ± 1.7 days, segmentectomy, P = 0.051). Conclusions For patients with peripheral non-subpleural nodules, we observed that patients who underwent wedge resection had less lung function loss than those who underwent segmentectomy when their lung function was reviewed at the 6th month after surgery. Patients undergoing wedge resection had partial advantages over patients with segmental resection in terms of hospitalization cost, operation time and postoperative drainage, etc. Wedge resection, as a treatment for peripheral non-subpleural pulmonary nodules, seemed to have more advantages in preserving patients’ pulmonary function.

Pulmonary function changes after uniportal video-assisted thoracoscopic anatomical lung resection

“…This came in line with Feng et al who found that patients undergoing wedge resection had partial advantages over patients with segmental resection in terms of hospitalization cost, operation time and postoperative drainage. [23] Our findings showed that the pulmonary function at 6 months after operation decreased in both groups. No significant statistical differences were found on postoperative FEV 1 loss after different types of sublobar resection (wedge and segmentectomy resection).…”

“…[25] In harmony with our results Feng et al found that No significant divergences were discovered when comparing FEV1 loss (19.4±5.4% segmentectomy vs. 17.6±2.1% wedge resection, P =0.176), while all patients underwent uniportal VATS wedge resection or segmentectomy. [23] Previous studies have confirmed that the FEV 1 loss in patients undergoing thoracotomy is significantly greater than that in patients undergoing thoracoscopic surgery [26] , they considered that the changes of FEV 1 after pneumonectomy might be related to surgical approach, similar views have also been accepted by other researchers. [27] A 2017 comprehensive systematic review concluded that postoperative pulmonary function stabilized approximately 6-12 months after surgery and that postoperative FEV1 loss was 4%e7% greater after lobectomy than after segmentectomy.…”

“…Several patients who underwent segmentectomy had more pronounced and dense stapler traces visible on chest CT when reviewed 3 months after surgery, which might restrict the re-expansion of remaining lung, data analysis also confirmed this notion. [23] However, previous studies have noticed that due to various reasons (different pulmonary function interval time, impacts caused by surgical incisions and different re-expansion after various extent of resection, etc. ), postoperative pulmonary function might be inaccurately predicted by segment counting method.…”

“…Interestingly, a study has pointed out that not all segmentectomies preserve pulmonary function well, even sometimes lobectomy preserves more lung function relative to segmentectomy [35] , this study results also equally corroborated Feng et al view. [23] Whether minimally invasive procedures are associated with better preservation of pulmonary function also remains controversial. In an early 1997 prospective study of thoracotomy and thoracoscopic wedge no significant difference was found in postoperative lung function 4 months after surgery.…”

Regional ventilation distribution before and after laparoscopic lung parenchymal resection

“…lobectomy, wedge resection) may also have influences (Asamura et al 2017, Divisi et al 2020, Nakagawa et al 2021. Patients usually experience partial loss of lung function after surgery (Feng et al 2022). Risk factors and prediction for postoperative lung functions are studied previously (Fan et al 2023, Tsubokawa et al 2023.…”