右S2および左S1+2区域切除術の有効性：肺葉切除術との肺機能比較

Residual lobar shifting after lobectomy promotes effective lung expansion and occasionally better-than-expected preservation of pulmonary function. Our previous study found that patients with lobar shifting (shift group) exhibited considerably better preservation of forced expiratory volume in 1 second (FEV₁) than those without it (nonshift group). During left upper lobectomy, however, no significant difference in FEV₁ preservation was noted between the groups, although our results tended to favor the nonshift group. Although segmentectomy is generally better at preserving pulmonary function than lobectomy, lobar shifting after lobectomy may alter outcomes. This study aimed to identify which segmentectomy sites better preserve pulmonary function compared with lobectomy while considering lobar shifting.

We analyzed 324 segmentectomies and 839 lobectomies from 2012 to 2024, excluding middle lobe resections. Lobar shifting, evaluated using 3-dimensional computed tomography 6 months after surgery, was categorized based on middle lobe, lingular, and left lower lobe bronchus displacement. Pulmonary function tests were conducted before and 6 months after surgery. FEV₁, vital capacity, and forced vital capacity preservation rates between the segmentectomy and shift or nonshift groups were compared according to resection site.

Significant differences in FEV₁ preservation between lobectomy and segmentectomy were observed only for right S2 (P < .001) and left S1 + 2 (P = .002), with both regions also showing significant differences in vital capacity and forced vital capacity.

Even under conditions favorable for preserving pulmonary function after lobectomy considering lobar shifting, segmentectomy of right S2 and left S1+2 resulted in better postoperative function.