Left Upper Division Segmentectomy Compared with Lobectomy for Lung Expansion and Bronchus Tortuosity

Area of Science:

• Thoracic Surgery
• Pulmonary Medicine
• Surgical Oncology

Background:

• The functional benefit of left upper division segmentectomy versus left upper lobectomy for left upper lobe lesions is debated.
• Evaluating clinical and functional outcomes is crucial for surgical decision-making.

Purpose of the Study:

• To compare clinical and functional outcomes between left upper lobectomy and left upper division segmentectomy.
• To assess the impact of each procedure on lung volume, bronchial geometry, and postoperative respiratory symptoms.

Main Methods:

• Retrospective analysis of 135 patients with left upper lobe lesions (110 lobectomy, 25 segmentectomy).
• Propensity score matching to compare groups.
• Spirometry, CT volume assessment (bronchus angle/tortuosity), and medical record review for symptoms.

Main Results:

• Segmentectomy group had smaller tumors but similar preoperative characteristics post-matching.
• Postoperative spirometry was similar; however, segmentectomy showed a smaller decrease in lung volume (p=0.004).
• Lobectomy group exhibited increased left main bronchus curvature (p=0.013) and higher rates of persistent cough (p=0.001).

Conclusions:

• Left upper division segmentectomy may prevent significant bronchial angulation.
• Segmentectomy appears promising for reducing postoperative persistent cough in lung cancer patients.
• This approach could be a viable alternative to lobectomy for select left upper lobe lesions.