Pulmonary Functional Impact of Resecting Additional Ipsilateral Ground-Glass Opacities: A Retrospective Propensity Score-Matched Study.

BACKGROUND

The 1-year pulmonary functional impact of resecting additional ipsilateral ground-glass opacities (GGOs) during unilateral surgery remains uncertain. We evaluated whether resection of multiple ipsilateral GGOs is associated with less favorable postoperative pulmonary function preservation than resection of a single lesion.

METHODS

We retrospectively analyzed patients with at least two ipsilateral GGOs who underwent pulmonary surgery between January 2020 and December 2024. Patients were grouped according to whether 1 lesion or ≥ 2 lesions were resected during the index operation. The primary outcomes were 1-year retention of FVC, FEV1, and DLCOc-SB.

RESULTS

A total of 291 patients were included; 146 underwent resection of 1 lesion and 145 underwent resection of ≥ 2 lesions. After propensity score matching, 232 patients remained (116 per group). In the matched cohort, absolute postoperative FVC, FEV1, and DLCOc-SB at 1 year were similar between groups. However, resection of ≥ 2 lesions was associated with greater declines and lower retention of FVC (90.41% vs. 94.55%; p < 0.001), FEV1 (87.10% vs. 93.73%; p < 0.001), and DLCOc-SB (91.04% vs. 93.70%; p = 0.016). In multivariable analyses, resection of ≥ 2 lesions remained independently associated with lower FEV1, FVC, and DLCOc-SB retention. Operative time was longer in the ≥ 2-lesion group, whereas other perioperative outcomes were similar.

CONCLUSIONS

Among surgically fit patients with multiple ipsilateral GGOs, resection of ≥ 2 lesions was associated with less favorable pulmonary function preservation than resection of a single lesion, suggesting a functional trade-off when considering resection of additional ipsilateral lesions.