The difference in postoperative pulmonary functional change between upper and lower thoracoscopic lobectomy.

Area of Science:

• Thoracic Surgery
• Pulmonary Medicine
• Medical Imaging

Background:

• Lung cancer treatment often involves lobectomy.
• Choosing between upper and lower lobectomy impacts postoperative outcomes.
• 3D imaging aids in assessing lung function changes.

Purpose of the Study:

• To compare postoperative functional changes after thoracoscopic upper lobectomy (UL) versus lower lobectomy (LL).
• To evaluate lung volumetric and morphological differences post-surgery.

Main Methods:

• Matched cohort study of 290 lung cancer patients (145 UL, 145 LL).
• Pre- and 6-month post-operative spirometry and CT scans.
• 3D lung volumetric and morphological analyses.

Main Results:

• Lower lobectomy (LL) showed significantly better postoperative forced expiratory volume in 1 second (FEV1) compared to upper lobectomy (UL).
• Increased volumes in residual and contralateral lung lobes observed post-LL and UL.
• Better maintenance of lung structural complexity (D-value) in the left lung after LL.

Conclusions:

• Thoracoscopic lower lobectomy (LL) offers superior pulmonary function compared to upper lobectomy (UL).
• LL promotes more robust pulmonary reserves and upward displacement of remaining lung tissue.
• These findings support LL for potentially better long-term respiratory outcomes.