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

In early-stage lung cancer, lung function appears to be less compromised after segmentectomy than lobectomy, though the advantage seems modest. We aimed to re-assess postoperative lung function in surgical patients, with a particular focus on the diffusion capacity for carbon monoxide (DL_CO). We evaluated all patients who underwent either lobectomy or segmentectomy for T1a-c lung cancer at our center between March 2016 and March 2023. From January to June 2024, patients who had undergone segmentectomy, along with a matched cohort of patients who had undergone lobectomy, were invited for a repeat lung function evaluation. Patients were matched 1:1 based on age, sex, surgical approach, year in which the procedure was performed, and tumor location. Lung function testing data including DL_CO were then compared to preoperative measures. During the study period, 480 patients received a lobectomy, and 97 received a segmentectomy. Complete lung function evaluation for the study was available for 52 patients (26 matched pairs). The median time from lung resection to repeat spirometry was 35 months. A modest reduction of lung function measures was observed in the segmentectomy group. Conversely, all lung function measures, including DL_CO, were significantly impaired in the lobectomy group. In early-stage lung cancer, patients who perform segmentectomy demonstrated better long-term lung function preservation compared to those who underwent lobectomy. Whenever feasible, segmentectomy should be considered the procedure of choice for early-stage lung cancer patients.