Lung segmentectomy: does it offer a real functional benefit over lobectomy?

Anne Charloux; Elisabeth Quoix

doi:10.1183/16000617.0079-2017

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FIGURE 1
Flow chart showing the results of the bibliographic search. PFT: pulmonary function test.
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FIGURE 2
Attempt to evaluate changes in forced expiratory volume in 1 s (FEV₁) with time after lobectomy and segmentectomy. Changes are expressed as a percentage of the pre-operative FEV₁ value. Logarithmic trendlines are the best-fit curved lines to the data. Data from [4–6, 8–11, 13–16].

TABLE 1

Studies providing pre- and post-segmentectomy pulmonary function tests (PFTs)

First author [ref.]	Year	Patients n	Open/VATS	PFT delay months	Initial FEV₁ % pred	FEV₁ variation %	Initial D_LCO % pred	D_LCO variation %	Initial FVC % pred	FVC variation %
Ginsberg [4]	1995	71	Open	6		−1.76±15.3				+1.93±19.4
				12–18		−5.18±16.1				+0.52±22.1
Takizawa [16]	1999	40	Open	0.5	105.0±23.6	−26.7±16.4			101.4±16.5	−27.3±12.5
				12		−6.7±10.3				−5.1±10.6
Yoshikawa [18]	2002	55	Open	12		−13.4±10.4				−11.3±9.8
Keenan [8]	2004	54	Open	12	55.3±3.0	−5^#	67.5±3.0	−17^#	72.8±2.5	−5^#
Martin-Ucar [11]	2005	34	Both	4 (3–6)	45 (19–54)	+12 (−2 to +47)
Harada [5]	2005	38	Mini-thoracotomy	2 6	75.0±3.8	−15^# −12^#			3.13±0.67 L^¶	−15^# −10^#
Okada [13]	2006	168	Open	2	2.32±0.64 L^¶	−9.4^#			3.16±0.84 L^¶	−10.4^#
Yoshimoto [19]	2009	56	NA	12 (6–24)	2.2±0.6 L^¶	−12±9			109±14
Watanabe [17]	2009	41	VATS	6	74.2±10.4	−3^#			110.4±25.6	−7^#
Kashiwabara [7]	2009	71	Open	6	109.4±20.8	Normal FEV₁: −12.9±8.7; FEV₁ <70%: −13.8±9.9			111.15±12.3	Normal FEV₁: −13.4±8.6; FEV₁ <70%: −16.0±11.8
Saito [14]	2014	52	Open	1	77.6±7.7	−28±7			107.1±19.9	−14±6
				6		−19±7				−10±5
Hwang [6]	2015	94	VATS	NA	101.6±24.0	−8.9±10.8	92.7±17.4		100.8±16.3
Kim [9]	2015	73	VATS	3	100.1±18.9	−4.83±8.74	104.2±20.7	−3.44±11.49	99.7±13.8	−4.45±7.30
				12		−2.75±8.10		−0.38±22.11		−2.01±8.33
Macke [10]	2015	89	Both	6–36	79±22	−4.3±17.4	63±22	−3.6±15.8
Suzuki [15]	2016	37	Both	2	73.3±9	−18.6^#			3.06±0.68 L^¶	−18.2^#
				7–12		−12.2^#				−6.6^#
Nomori [12]⁺	2016	117	Open	7 (6–13)	<2 seg: 105±23; ≥2 seg: 114±23; LUD: 117±27	<2 seg: −3±10; ≥2 seg: −10±9; LUD: −16±7

Data are expressed as mean±sd or mean (range). Variation data are relative to the initial values. VATS: video-assisted thoracic surgery; FEV₁: forced expiratory volume in 1 s; D_LCO: diffusing capacity of the lung for carbon monoxide; FVC: forced vital capacity; Open: thoracotomy; Both: VATS and thoracotomy; NA: not available. ^#: calculated from data or extracted from figures; ^¶: absolute values in L given where no % pred values available; ⁺: compared resections <2 segments (<2 seg), ≥2 segments (≥2 seg), and of the left upper division (LUD).

TABLE 2

Studies comparing lobectomy and segmentectomy functional consequences

First author [ref.]	Year	Procedure	Patients n	Mean pre-operative FEV₁ % pred	PFT delay months	Mean FEV₁ change %
Ginsberg [4]	1995	Lobectomy	71	93% patients >50%	6	−9.1
					12–18	−11.09
		Segmentectomy	67	93% patients >50%	6	−1.76^#
					12–18	−5.18^#
Takizawa [16]	1999	Lobectomy	40	105	0.5	−26.7
					12	−13.7
		Segmentectomy	40	109	0.5	−24.5^#
					12	−6.7^#
Keenan [8]	2004	Lobectomy	147	75	12	−10^¶
		Segmentectomy	54	55	12	−5^¶
Martin-Ucar [11]	2005	Lobectomy	12	44	3–6	−12
		Segmentectomy	11	45	3–6	+12^#
Harada [5]	2005	Lobectomy	45	74	2	−24^¶
					6	−18^¶
		Segmentectomy	38	75	2	−15^#,¶
					6	−12^#,¶
Okada [13]	2006	Lobectomy	168	2.32 L⁺	2	−16.8
		Segmentectomy	168	1.93 L⁺	2	−9.4
Kashiwabara [7]	2009	Lobectomy	47	107	6	Normal FEV₁: −18.9
						FEV₁ <70%: −12.8
		Segmentectomy	71	109	6	Normal FEV₁: −12.9^#
						FEV₁ <70%: −13.8
Saito [14]	2014	Lobectomy	126	77	1	−28
					6	−19
		Segmentectomy	52	78	1	−22
					6	−10^#
Hwang [6]	2015	Lobectomy	94	101	NA	−11.0
		Segmentectomy	94	102	NA	−8.9
Kim [9]	2015	Lobectomy	227	109	3	−13.6
					12	−8.49
		Segmentectomy	73	100	3	−4.84^#
					12	−1.74^#
Macke [10]	2015	Lobectomy	70	85	6–36	−8.2
		Segmentectomy	89	79	6–36	−4.3^#
Suzuki [15]	2016	Lobectomy	33	75	2	−29
					7–12	−11
		Segmentectomy	37	73	2	−19
					7–12	−12
Nomori [12]^§	2016	Segmentectomy	117	<2 seg: 105	7 (6–13)	<2 seg: −3^#
				≥2 seg: 114		≥2 seg: −10^#
				LUD: 117		LUD: −16
		Lobectomy	13	LUL: 114		LUL: −17

FEV₁: forced expiratory volume in 1 s; PFT: pulmonary function test; NA: not available. ^#: significant difference between lobectomy and segmentectomy; ^¶: calculated from data or extracted from figures; ⁺: absolute values in L given where no % pred values available; ^§: compared resections <2 segments (<2 seg), ≥2 segments (≥2 seg), of the left upper division (LUD) and left upper lobectomy (LUL).