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Sublobar resection: functional evaluation and pathophysiological considerations.

Pierachille Santus1, Elisa Franceschi1, Dejan Radovanovic1

  • 1Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Division of Respiratory Diseases, Ospedale L. Sacco, ASST Fatebenefratelli-Sacco, Milan, Italy.

Journal of Thoracic Disease
|July 10, 2020
PubMed
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Pulmonary function tests (PFTs) like FEV1 are standard in lung surgery but limited. Combining spirometry with lung volumes and ventilation distribution offers a better assessment of surgical impact.

Area of Science:

  • Thoracic Surgery
  • Pulmonary Medicine
  • Respiratory Physiology

Background:

  • Pulmonary function tests (PFTs) are standard in thoracic surgery for risk assessment and outcome prediction after pulmonary resections.
  • Current practice primarily relies on forced expiratory volume in one second (FEV1), which inadequately reflects lung pathophysiology, especially in emphysema.
  • The predictive value of spirometry for guiding surgical extent in lung resections remains unclear.

Purpose of the Study:

  • To critically review existing literature on PFTs in lung surgery.
  • To highlight limitations of current spirometry use in assessing patients undergoing pulmonary resections.
  • To propose improved methods for evaluating lung mechanics and functional outcomes post-surgery.

Main Methods:

Keywords:
Pathophysiologyforced expiratory volume in one second (FEV1)lobectomylung mechanicssegmentectomy

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  • Critical overview of four studies comparing pre- and post-surgery FEV1 and forced vital capacity (FVC) in lobectomy and segmentectomy patients.
  • Analysis of literature focusing on spirometric parameters and their interpretation in lung surgery.
  • Discussion of the role of static lung volumes, body-plethysmography, and ventilation distribution indexes.

    • Main Results:

    • Limited literature exists, often with inhomogeneous samples, hindering accurate analysis of post-surgical function loss and recovery.
    • FEV1 alone poorly represents lung pathophysiology in patients with emphysema and airflow obstruction.
    • Static lung volumes, lung compliance, and closing volume changes are critical considerations, particularly in emphysema patients undergoing lobectomy.

    Conclusions:

    • Spirometry, particularly FEV1, is insufficient for comprehensive pre-operative assessment in lung surgery.
    • Integrating static lung volumes and ventilation distribution measures with spirometry is crucial for better functional evaluation.
    • Further prospective studies are needed to establish the relationship between surgical approaches, lung mechanics, and long-term functional loss.