Elsevier

The Annals of Thoracic Surgery

Volume 80, Issue 6, December 2005, Pages 2041-2045
The Annals of Thoracic Surgery

Original article
General thoracic
Functional Advantage After Radical Segmentectomy Versus Lobectomy for Lung Cancer

https://doi.org/10.1016/j.athoracsur.2005.06.010Get rights and content

Background

Although several reports have recently demonstrated that segmentectomy for small-sized N0 lung cancer leads to recurrence and survival rates equivalent to those associated with lobectomy, controversy regarding the postoperative functional advantage in the former over the latter still persists. The purpose of this study was to evaluate the degree of postoperative functional loss in patients undergoing segmentectomy or lobectomy for lung cancer.

Methods

We analyzed patients able to tolerate lobectomy, who underwent radical segmentectomy (n = 38) or lobectomy (n = 45) for non–small-cell lung cancer. Functional testing included forced vital capacity, forced expiratory volume in 1 second, and anaerobic threshold measured preoperatively and at 2 and 6 months after surgery.

Results

Preoperative function tests showed no differences between segmentectomy and lobectomy patients. A positive and significant correlation was found between the number of resected segments versus loss of forced vital capacity (r = 0.518, p < 0.0001 at 2 months; r = 0.604, p < 0.0001 at 6 months) and loss of forced expiratory volume in 1 second (r = 0.492, p < 0.0001 at 2 months; r = 0.512, p < 0.0001 at 6 months). The postoperative reduction of forced vital capacity (p = 0.0006) and forced expiratory volume in 1 second (p = 0.0007) was significantly less in the segmentectomy group; however, a marginally significant benefit was observed in this group for anaerobic threshold (p = 0.0616).

Conclusions

The extent of removed lung parenchyma directly affected that of postoperative functional loss even at 6 months after surgery, and segmentectomy offered significantly better functional preservation compared with lobectomy. These results indicate the importance of segmentectomy for early staged lung cancer.

Section snippets

Patients and Methods

The study group consisted of 83 patients: 45 of them underwent lobectomy and the other 38 underwent segmentectomy. This study was conducted with the approval of the institutional ethics board and informed consent was obtained from all patients. No specific preoperative and postoperative rehabilitation programs were established.

The eligibility criteria for segmentectomy in this study were as follows: patients who had a cT1N0M0 non–small-cell lung cancer 2 cm or smaller in all dimensions on

Results

The clinical preoperative characteristics and average number of resected segments in the lobectomy and the segmentectomy groups are shown in Table 1. There were no significant differences in preoperative functional factors between the two groups, confirming that the patients with segmentectomy included in this study could tolerate a lobectomy. The number of segments actually removed was halved in the case of segmentectomy (1.9 ± 0.9 versus 3.9 ± 1.1). The cell type of the tumor was

Comment

One of the controversies regarding lesser resection is whether the procedure itself can provide postsurgical functional benefit or not. There have been two reports suggesting that limited resection, including segmentectomy, could provide little functional advantage over lobectomy [1, 13]. In 1995, the Lung Cancer Study Group showed no significant differences in FVC between patients undergoing lobectomy and those undergoing limited resection [1]. Despite the fact that their data demonstrated a

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