Sublobar resection reduces the risk of postoperative cognitive dysfunction compared with lobectomy

Area of Science:

• Thoracic Surgery
• Oncology
• Neuroscience

Background:

• Sublobar resection (wedge resection, segmentectomy) is a viable alternative to lobectomy for early-stage non-small cell lung cancer.
• Postoperative cognitive dysfunction (POCD) is a concern following major surgeries, including lung cancer resections.

Purpose of the Study:

• To compare the incidence of POCD between sublobar resection and lobectomy in patients with early-stage non-small cell lung cancer.
• To evaluate the impact of surgical approach on short-term cognitive function after lung cancer surgery.

Main Methods:

• Prospective cohort study involving 335 patients undergoing either sublobar resection or lobectomy.
• Cognitive function assessed pre- and post-surgery using Montreal Cognitive Assessment and Minimum Mental State Examination.
• Propensity score matching (PSM) used to balance demographic characteristics between groups.

Main Results:

• Lower POCD rates at 1 day and 1 month post-surgery in the sublobar group (5.5% vs 18.2%, P < 0.001; 7.9% vs 21.8%, P < 0.001) before matching.
• After PSM, sublobar resection still showed significantly lower POCD rates at 1 day (5.3% vs 17.3%, P = 0.005) and 1 month (8.3% vs 18.8%, P = 0.018).
• Minimum Mental State Examination abnormalities were also lower in the sublobar group, particularly at 1 month post-surgery (P = 0.026 after PSM).

Conclusions:

• Sublobar resection demonstrates a significant advantage in preventing postoperative cognitive dysfunction compared to lobectomy.
• These findings provide valuable evidence for surgical decision-making in early-stage non-small cell lung cancer, prioritizing cognitive preservation.