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

Anne Charloux, Elisabeth Quoix
European Respiratory Review 2017 26: 170079; DOI: 10.1183/16000617.0079-2017
Anne Charloux
1Physiology and Functional Explorations Dept, University Hospital, Strasbourg, France
2EA 3072, Federation of Translational Medicine, Strasbourg University, Strasbourg, France
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  • For correspondence: anne.charloux@chru-strasbourg.fr
Elisabeth Quoix
3Pulmonology Dept, University Hospital, Strasbourg, France
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  • Article
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Figures

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  • FIGURE 1
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    FIGURE 1

    Flow chart showing the results of the bibliographic search. PFT: pulmonary function test.

  • FIGURE 2
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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].

Tables

  • Figures
  • TABLE 1

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

    First author
    [ref.]
    YearPatients
    n
    Open/VATSPFT delay
    months
    Initial
    FEV1 % pred
    FEV1
    variation %
    Initial
    DLCO % pred
    DLCO variation %Initial FVC % predFVC
    variation %
    Ginsberg [4]199571Open6−1.76±15.3+1.93±19.4
    12–18−5.18±16.1+0.52±22.1
    Takizawa [16]199940Open0.5105.0±23.6−26.7±16.4101.4±16.5−27.3±12.5
    12−6.7±10.3−5.1±10.6
    Yoshikawa [18]200255Open12−13.4±10.4−11.3±9.8
    Keenan [8]200454Open1255.3±3.0−5#67.5±3.0−17#72.8±2.5−5#
    Martin-Ucar [11]200534Both4 (3–6)45 (19–54)+12 (−2 to +47)
    Harada [5]200538Mini-thoracotomy2
    6
    75.0±3.8−15#
    −12#
    3.13±0.67 L¶−15#
    −10#
    Okada [13]2006168Open22.32±0.64 L¶−9.4#3.16±0.84 L¶−10.4#
    Yoshimoto [19]200956NA12 (6–24)2.2±0.6 L¶−12±9109±14
    Watanabe [17]200941VATS674.2±10.4−3#110.4±25.6−7#
    Kashiwabara [7]200971Open6109.4±20.8Normal FEV1: −12.9±8.7;
    FEV1 <70%: −13.8±9.9
    111.15±12.3Normal FEV1: −13.4±8.6;
    FEV1 <70%: −16.0±11.8
    Saito [14]201452Open177.6±7.7−28±7107.1±19.9−14±6
    6−19±7−10±5
    Hwang [6]201594VATSNA101.6±24.0−8.9±10.892.7±17.4100.8±16.3
    Kim [9]201573VATS3100.1±18.9−4.83±8.74104.2±20.7−3.44±11.4999.7±13.8−4.45±7.30
    12−2.75±8.10−0.38±22.11−2.01±8.33
    Macke [10]201589Both6–3679±22−4.3±17.463±22−3.6±15.8
    Suzuki [15]201637Both273.3±9−18.6#3.06±0.68 L¶−18.2#
    7–12−12.2#−6.6#
    Nomori [12]+2016117Open7 (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; DLCO: 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.]YearProcedurePatients nMean pre-operative FEV1 % predPFT delay monthsMean FEV1 change %
      Ginsberg [4]1995Lobectomy7193% patients >50%6−9.1
      12–18−11.09
      Segmentectomy6793% patients >50%6−1.76#
      12–18−5.18#
      Takizawa [16]1999Lobectomy401050.5−26.7
      12−13.7
      Segmentectomy401090.5−24.5#
      12−6.7#
      Keenan [8]2004Lobectomy1477512−10¶
      Segmentectomy545512−5¶
      Martin-Ucar [11]2005Lobectomy12443–6−12
      Segmentectomy11453–6+12#
      Harada [5]2005Lobectomy45742−24¶
      6−18¶
      Segmentectomy38752−15#,¶
      6−12#,¶
      Okada [13]2006Lobectomy1682.32 L+2−16.8
      Segmentectomy1681.93 L+2−9.4
      Kashiwabara [7]2009Lobectomy471076Normal FEV1: −18.9
      FEV1 <70%: −12.8
      Segmentectomy711096Normal FEV1: −12.9#
      FEV1 <70%: −13.8
      Saito [14]2014Lobectomy126771−28
      6−19
      Segmentectomy52781−22
      6−10#
      Hwang [6]2015Lobectomy94101NA−11.0
      Segmentectomy94102NA−8.9
      Kim [9]2015Lobectomy2271093−13.6
      12−8.49
      Segmentectomy731003−4.84#
      12−1.74#
      Macke [10]2015Lobectomy70856–36−8.2
      Segmentectomy89796–36−4.3#
      Suzuki [15]2016Lobectomy33752−29
      7–12−11
      Segmentectomy37732−19
      7–12−12
      Nomori [12]§2016Segmentectomy117<2 seg: 1057 (6–13)<2 seg: −3#
      ≥2 seg: 114≥2 seg: −10#
      LUD: 117LUD: −16
      Lobectomy13LUL: 114LUL: −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).

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      Lung segmentectomy: does it offer a real functional benefit over lobectomy?
      Anne Charloux, Elisabeth Quoix
      European Respiratory Review Dec 2017, 26 (146) 170079; DOI: 10.1183/16000617.0079-2017

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      Lung segmentectomy: does it offer a real functional benefit over lobectomy?
      Anne Charloux, Elisabeth Quoix
      European Respiratory Review Dec 2017, 26 (146) 170079; DOI: 10.1183/16000617.0079-2017
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