Negative impact of chemical pleurodesis on postoperative pulmonary function for managing prolonged air leakage after...

Prolonged air leakage (PAL) is the most common postoperative complication after segmentectomy and chemical pleurodesis (CP) is one of the common procedures for managing PAL. However, the impact of CP on postoperative pulmonary function remains unclear.

We performed a propensity score matching analysis for postoperative pulmonary function in lung cancer patients who underwent segmentectomy. The percentage of postoperative functional change of forced vital capacity (δFVC) and forced expiratory volume in 1 s (δFEV_1.0) at postoperative 6 and 12 months were compared between patients who were managed for PAL by CP (CP group, n = 21) and those who did not receive CP (non-CP, n = 21). The predicted δFVC and δFEV_1.0 after segmentectomy and lobectomy were also assessed to evaluate the loss of preserved lung function.

δFVC and δFEV_1.0 in the CP group were confirmed by a significantly larger decline in postoperative pulmonary function than that seen in the non-CP group at postoperative 6 and 12 months (δFVC at 6 months, - 21.1% versus - 5.1%, - 20.8% versus - 6.8% at 12 months, δFEV_1.0 at 6 months, - 19.1% versus - 7.2%, - 19.6% versus - 9.7%, at 12 months, p < 0.05 respectively). Both δFVC and δFEV_1.0 in the CP group were significantly lower than those predicted after segmentectomy (p < 0.01). They were not statistically different from the values predicted if lobectomy was performed.

CP after segmentectomy caused the same amount of loss in pulmonary function that was predicted if lobectomy was performed. The benefit of segmentectomy compared to lobectomy for preservation of pulmonary function is impaired by CP.