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Postoperative Pulmonary Function and Structural Remodelling After Lobectomy in Patients With and Without Chronic
Sanae Kuroda1, Tappei Shomoto1, Yuki Nishioka1
1Division of Chest Surgery, Hyogo Cancer Center, Akashi 673-8558, Japan.
Interdisciplinary Cardiovascular and Thoracic Surgery
|March 2, 2026
Summary
Patients with chronic obstructive pulmonary disease (COPD) show better postoperative lung function after lobectomy than predicted, with no added structural damage. Non-COPD patients experience increased low-attenuation areas (LAA) post-surgery.
Area of Science:
- Pulmonary Medicine
- Radiology
- Thoracic Surgery
Background:
- Quantitative lung structure assessment offers insights beyond standard postoperative function prediction.
- Chronic Obstructive Pulmonary Disease (COPD) status and emphysema distribution significantly impact lung function and structural changes after surgery.
Purpose of the Study:
- To investigate how preoperative COPD status and emphysema distribution influence postoperative pulmonary function and lung structural remodeling.
- To utilize three-dimensional computed tomography (3D-CT) cluster analysis for assessing these influences.
Main Methods:
- Retrospective analysis of 426 lobectomy cases (2018-2023), stratified into COPD and non-COPD groups.
- Estimation of predicted postoperative FEV1.0 using 3D-CT volumetry and calculation of measured-to-predicted FEV1.0 ratio (MPFR).
- Measurement of pre- and postoperative structural parameters (D-value for alveolar complexity, low-attenuation area (LAA)) using 3D-CT.
Main Results:
- COPD patients demonstrated a significantly higher MPFR (117.9%) compared to non-COPD patients (110.7%).
- %LAA was significantly higher in the non-COPD group.
- No significant difference in %D-value was observed between groups, but %LAA was higher in non-COPD patients.
Conclusions:
- COPD patients maintain better-than-predicted postoperative function without additional structural loss.
- Non-COPD patients exhibit volume-driven increases in LAA post-surgery.
- Integrating functional (MPFR) and structural (D-value, LAA) 3D-CT indexes enhances evaluation of postoperative lung remodeling, aiding risk stratification and surgical planning.
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