Postoperative Lung Function Advantages in Pulmonary Segmentectomy for Early-Stage Lung Cancer

Area of Science:

• Thoracic Surgery
• Pulmonary Medicine
• Oncology

Background:

• Lung function is crucial after early-stage lung cancer surgery.
• Previous studies suggest segmentectomy may preserve lung function better than lobectomy.
• The long-term impact on diffusion capacity for carbon monoxide (DLCO) requires further investigation.

Purpose of the Study:

• To re-assess long-term postoperative lung function, particularly DLCO, in patients who underwent segmentectomy versus lobectomy for early-stage lung cancer.
• To compare lung function changes from baseline in matched cohorts.
• To determine the preferred surgical approach for optimal lung function preservation.

Main Methods:

• Retrospective evaluation of patients with T1a-c lung cancer undergoing lobectomy or segmentectomy (March 2016-March 2023).
• Prospective repeat lung function evaluation (including DLCO) for segmentectomy patients and matched lobectomy patients (January-June 2024).
• 1:1 matching based on age, sex, surgical approach, year, and tumor location; comparison of pre- and post-operative measures.

Main Results:

• A modest reduction in lung function was observed in the segmentectomy group.
• Significant impairment in all lung function measures, including DLCO, was noted in the lobectomy group.
• 52 patients (26 matched pairs) completed repeat testing at a median of 35 months post-surgery.

Conclusions:

• Segmentectomy demonstrates superior long-term lung function preservation compared to lobectomy in early-stage lung cancer.
• Segmentectomy should be considered the procedure of choice when feasible for these patients.
• This supports lung-sparing surgical strategies for improved quality of life post-treatment.