Subsegmental resection preserves regional pulmonary function: A focus on thoracoscopy

Abstract

Background The aim of this study was to evaluate regional postoperative preserved pulmonary function (PPPF) and three‐dimensional (3D) volumetric changes according to the number of resected subsegments and investigate the factors that most affected pre‐/post PPPF. Methods Patients who underwent thoracoscopic lobectomy (n = 73), and segmentectomy (n = 87) were eligible for inclusion in the study. They were classified according to the number of resected subsegments which ranged from 1 to 10. The percentage of pre‐/postoperative forced expiratory volume in 1 s (FEV1) was used for comparison. Furthermore, lung volumetric changes were calculated using 3D computed tomography (CT) volumetry. Results The percentage of pre‐/postoperative EFV1 between 4 and 5–7 and between 5–7 and 10 were significant (p = 0.03 and p < 0.01, respectively), but not between 1–2 to 4 (p = 0.99). The difference between volumetric changes in the left lower lobe of patients with a number of resected subsegments was significant (p < 0.01). On univariate and multivariate analyses, chronic inflammation was significant for decrease in recovery percentages. When the PPPF was compared among resected subsegments, it gradually decreased with an increase in the number of patients without a postoperative procrastination of inflammation (p < 0.01). Conclusions Segmentectomy is feasible and useful for PPPF. Even a relatively large‐volume resection procedure where 5–7 subsegments are resected can preserve pulmonary function. Chronic inflammation was statistically identified as a risk factor for postoperative preserved pulmonary function. Key points

Pulmonary function changes after thoracoscopic lobectomy versus intentional thoracoscopic segmentectomy for early-stage non-small cell lung cancer

“…However, due to the limited sample size, they did not compare pulmonary function changes after different segmentectomies with the corresponding lobectomies. Kuroda et al detected significant differences in FEV1 preservation after VATS left upper lobe resections between 4 and 5-7 resected subsegments, and between 5-7 and 10 resected subsegments (29). But their study did not embark on resections of other lobes.…”

“…Only a limited number of retrospective small-sample studies have compared functional changes after lobectomy and segmentectomy in the VATS setting (24)(25)(26)(27)(28)(29)(30), among which few explored pulmonary function changes after different segmentectomies (25,29). Tane et al noticed that FEV1 could be better preserved after single segmentectomy than after combined segmentectomy (25).…”

Genomics Analysis and Nomogram Risk Prediction of Occult Lymph Node Metastasis in Non-Predominant Micropapillary Component of Lung Adenocarcinoma Measuring ≤ 3 cm

“…With the increasing popularity of low-dose spiral computed tomography (CT) screening, the incidence of early clinical T stage lung malignancy has been increasing ( 2 ). As the number of patients with small ground glass nodule increases, more thoracic surgeons have accepted segmental or subsegmental resection and selective lymph node dissection as optimized treatment modalities ( 3 , 4 ). However, there are still some patients with early clinical stage occur lymph node metastasis.…”

Novel strategy to treat lung metastases: Hybrid therapy involving surgery and radiofrequency ablation

“…Actually, among 26 tumors treated by RFA in this study, lobectomy or segmentectomy were required to treat 21 nodules if surgery was performed. It has been reported that VC and FEV 1.0 decrease 7.1%–19.2% and 8.7%–21.0% after lobectomy and 4.1%–15.0% and 6.2%–18.4% after segmentectomy, 32 , 33 , 34 , 35 respectively. Moreover, bilateral metastasectomy was reported to impair pulmonary function than unilateral surgery.…”