The dynamic pulmonary functional change after thoracoscopic lower lobe segmentectomy.

Area of Science:

• Thoracic Surgery
• Pulmonary Function Testing
• Medical Imaging

Background:

• The functional lung-sparing advantages of segmentectomy over lobectomy are debated.
• Lower lobe segmentectomies are categorized as simple (e.g., segment 6) or complex (basal segments).
• Three-dimensional computed tomography (3D-CT) volumetric analysis enables precise measurement of residual lung function.

Purpose of the Study:

• To compare residual lung function after thoracoscopic lower lobe segmentectomy versus lobectomy.
• To evaluate the impact of simple versus complex segmentectomy on lung function preservation.
• To utilize 3D-CT volumetric methods for quantitative assessment of pulmonary function post-surgery.

Main Methods:

• A propensity score-matched analysis compared 67 patients undergoing thoracoscopic lower lobe segmentectomy with 67 undergoing thoracoscopic lower lobectomy.
• Postoperative forced expiratory volume in 1 second (FEV1) decrease was compared between surgical groups.
• Regional FEV1 of the residual lobe was measured using volumetric and spirometric analyses, defining the preservation rate as the ratio of actual to predicted postoperative FEV1.

Main Results:

• Thoracoscopic segmentectomy demonstrated a significantly higher postoperative/preoperative FEV1 ratio (90.7%) compared to lobectomy (85.7%, p=0.001).
• No significant difference in preservation rates was observed between simple segmentectomy (82.2%) and complex segmentectomy (80.2%, p=0.709).
• Specific segmentectomies included S6 (n=43), S8 (n=7), S8+9 (n=3), S10 (n=7), and S9+10 (n=7).

Conclusions:

• Thoracoscopic lower lobe segmentectomy effectively preserves postoperative lung function compared to lobectomy.
• Complex segmentectomies yield lung function preservation outcomes comparable to simple segmentectomies.
• Segmentectomy is a viable option for maintaining pulmonary function in lower lobe resections.