Pulmonary function changes after different extent of pulmonary resection under video-assisted thoracic surgery

Area of Science:

• Thoracic Surgery
• Pulmonary Medicine
• Surgical Oncology

Background:

• Limited resections for early-stage lung cancer are gaining interest.
• Pulmonary function preservation after limited resections versus lobectomy in minimally invasive surgery remains unclear.

Purpose of the Study:

• To evaluate postoperative changes in spirometry after video-assisted thoracic surgery (VATS) lobectomy and limited resections.
• To compare pulmonary function preservation across different VATS resection extents.

Main Methods:

• Prospective spirometry tests before and 6 months after VATS lobectomy (75 patients), segmentectomy (34), and wedge resection (15).
• A control group (11 patients) underwent VATS mediastinal procedures without lung resection.
• Comparison of spirometry indices (FVC, FEV1, DLCO) between groups based on resection extent.

Main Results:

• Wedge resection showed significantly less Forced Vital Capacity (FVC) loss than lobectomy (P<0.001) and segmentectomy (P=0.048).
• Forced Expiratory Volume in 1 second (FEV1) loss was significantly greater after lobectomy and segmentectomy compared to wedge resection (P<0.01).
• Diffusing capacity of the lungs for carbon monoxide (DLCO) loss was similar across lobectomy, segmentectomy, and wedge resection (P=0.293). Pulmonary function loss per segment resected was double for VATS segmentectomy compared to VATS lobectomy.

Conclusions:

• Wedge resection best preserves pulmonary function in VATS surgery, with spirometry changes similar to mediastinal procedures without lung resection.
• VATS segmentectomy may reduce FVC loss compared to lobectomy, but not FEV1 or DLCO.
• The extent of resection significantly impacts pulmonary function; loss per segment is higher in segmentectomies than lobectomies, guiding surgical decisions for early-stage lung cancer.