Volumetric Compensation After Anatomical Lung Resection: Comparative Analysis of Lobectomy and Segmentectomy

To compare postoperative lung function and volume compensation in lung cancer patients after lobectomy or segmentectomy.

We retrospectively reviewed patients who underwent initial lung cancer surgery between 2019 and 2021. Of 1076 patients, 870 underwent lobectomy and 206 segmentectomy. Propensity score matching (PSM) of 1:2 was performed using age, sex, smoking status, and preoperative pulmonary function tests (PFTs). Total lung volume (TLV) was calculated using deep learning-assisted 3D lung segmentation on thin-section computed tomography images. Postoperative lung volumes were compared with predicted postoperative (PPO) volumes and correlated with PFT results.

After matching, 378 lobectomy and 189 segmentectomy patients were included. TLV reduction was similar between groups, but contralateral lung volume (CLV) increased more after lobectomy (P = .010). Diffusing capacity of the lung for carbon monoxide was better preserved after segmentectomy (P = .029), whereas force vital capacity and forced expiratory volume in 1 second (FEV1) were similar. Actual postoperative PFT values exceeded predicted values in both groups, but the discrepancy was larger after lobectomy (P < .001). In segmentectomy, single-segment resection showed no compensation, while multiple-segment resections had variable compensation patterns. Ipsilateral lung volume changes contributed more than CLV changes, and compensation patterns varied by lobe. The TLV change correlated with forced vital capacity and FEV1 but not diffusing capacity of the lung for carbon monoxide.

Lobectomy induced greater CLV compensation than segmentectomy. Although overall lung function preservation was similar, lobectomy resulted in a greater difference between actual and PPO pulmonary function.