Postoperative outcomes in pulmonary nodule patients: a comparative analysis of aggressive vs. conservative management

There is no standard treatment for pulmonary nodules (PNs) detected through computed tomography (CT) scan. Both aggressive intervention and conservative monitoring present their respective advantages and disadvantages. To investigate the impact of aggressive management and conservative management on lung cancer diagnosis rates, postoperative symptoms, and patients' postoperative psychological status after surgeries, the survey was conducted.

A total of 604 patients were enrolled and divided into two groups: the aggressive management group (n=441), with surgery within 365 days after initial CT scan of the nodule, and the conservative management group (n=163), with surgery after a follow-up period exceeding 365 days. Clinical data, imaging characteristics after diagnosis of PNs and pathological diagnosis after the surgery were collected. Other information, including postoperative symptoms, survival, and assessments of anxiety, depression, and sleep disorders were followed up by phone. Changes in nodule size and density were assessed and categorized as unchanged, increased, or decreased by comparing initial and preoperative CT scans. We employed propensity score-matched analysis and multivariable logistic regression to examine the associations between treatment groups and 3-month symptoms, as well as 3-year quality-of-life indicators.

After propensity score matching, a total of 396 patients were included in the analysis, including 132 in the conservative group and 264 in the radical group. The aggressive management group had 215 cases (81.4%) of lung cancer diagnosis, having a lower incidence rate than the conservative management group with 118 cases (89.4%). The aggressive management group presented with a lower frequency of invasive adenocarcinoma (IA) type (9.5% vs. 27%) and a higher frequency of minimally invasive adenocarcinoma (MIA) type (69% vs. 52%) compared to the conservative management group (P=0.001). Moreover, in the aggressive management group, the prevalence of IA stage was significantly higher compared to the conservative management group (97% vs. 92%). Conversely, the combined percentage of the IB stage and subsequent stages was notably lower in the aggressive management group than in the conservative one (2.3% vs. 8.5%, P=0.02). Logistic regression identified aggressive management as a risk factor for postoperative cough [odds ratio (OR) =3.34; 95% confidence interval (CI): 2.08-5.52], pain (OR =2.15; 95% CI: 1.35-3.49), and shortness of breath (OR =1.89; 95% CI: 1.15-3.20) (all P<0.05), but it acted as a protective factor against anxiety and depression (OR =0.14; 95% CI: 0.02-0.57). Subgroup analysis revealed female gender (P<0.05) and malignancy diagnosis (P<0.05) independently associated with pain and respiratory symptoms, respectively. Non-smoking status was positively associated with cough (P<0.05).

Aggressive management effectively reduces IA-type incidence and boosts early detection of stage IA lung cancer, yet it may increase postoperative symptoms like cough, pain, and dyspnea, risking overtreatment. Nonetheless, it may positively alleviate the postoperative anxiety and depression in patients.