Lung volume evaluation of modified Nuss procedure for pectus excavatum using three-dimensional computed tomography: A...

The Nuss procedure is widely used for Pectus excavatum (PE) repair. This study aimed to evaluate the efficacy of the modified Nuss procedure and identify prognostic factors by analyzing lung volume (LV) changes via three-dimensional computed tomography (3D-CT).

PE patients receiving the modified Nuss procedure between 2019 and 2022 were retrospectively reviewed. 3D-CT was performed preoperatively, postoperatively, and at 2-year postoperatively to measure the volume of each lung, lobe and segment. Chi-square test or Fisher's exact test was used for intergroup comparisons. Univariate and multivariate linear regression analyses were used to screen predictors.

A total of 87 PE patients were included. Preoperative CT assessment showed a median Haller Index (HI) of 3.5. Postoperative LVs of most lobes and segments significantly decreased initially but improved markedly at 2 years postoperatively (P< 0.05). Significant improvement in the volumes of left lateral basal segment (LS9) and right lateral basal segment (RS9) were observed in patients with mild PE. Multivariate analysis revealed male gender, higher preoperative LV, and weight as positive predictors of long-term postoperative LV recovery, while higher HI and prolonged postoperative hospital stay were negative predictors. Higher HI was associated with a sustained negative effect on the recovery of multiple lung segments.

The modified Nuss procedure provides segment-specific improvement in long-term LVs measured by 3D-CT in PE patients, with distinct recovery patterns related to HI. Severe PE can result in more extensive and potentially irreversible pulmonary parenchymal damage.