Pulmonary vascular changes after lung resection: why less may be more

Pneumonectomy is a surgical procedure that has been performed since 1933. It is associated with an estimated 90-day mortality rate of 7%. For this reason, pneumonectomy has been increasingly replaced by less extensive lung resections. Lobectomy has been used widely since the mid-twentieth century and is associated with significantly lower perioperative mortality and morbidity. However, any major lung resection has implications for pulmonary hemodynamics. Studies show that lobectomy carries a significant burden of cardiorespiratory morbidity, with notable exertional intolerance and exercise-induced pulmonary hypertension. Segmentectomy is another parenchyma-sparing form of lung resection that has gained increasing attention in recent years. For carefully selected non-small cell lung cancers of limited size, studies suggest that segmentectomy results in better survival rates compared to lobectomy. Because segmentectomy removes less lung parenchyma and associated vasculature than lobectomy, the impact on the pulmonary vascular system will be limited. In this review, we aim to summarize the current literature regarding the effects of different types of lung resections on pulmonary vasculature and the underlying pathophysiological mechanisms.