The Journal of thoracic and cardiovascular surgery · 2026
Three-dimensional computed tomography volumetry and pulmonary function outcomes after segmentectomy versus lobectomy.
СтатьяНаблюдательное исследованиеСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Nakamura Masaya, Goto Tatsuya, Koike Terumoto, Tanaka Takahiro, Hashimoto Atsushi, Miyazawa Haruna, Tanaka Mototsugu, Shimizu Yuki, Tsuchida Masanori
Аннотация
OBJECTIVES: Recent randomized trials have demonstrated that sublobar resection, including segmentectomy, provides noninferior overall survival compared with lobectomy in early-stage non-small cell lung cancer. However, these trials have shown unexpectedly small differences in postoperative pulmonary function. Compensatory expansion of the residual lung may explain these limited differences. Therefore, we used 3-dimensional computed tomography volumetry to quantify compensatory expansion of the residual lung and clarify its role in functional preservation after segmentectomy compared with lobectomy.
METHODS: In this prospective observational study we analyzed 51 patients who underwent segmentectomy and 64 patients who underwent lobectomy. Three-dimensional computed tomography volumetry was performed preoperatively and at 12 months postoperatively to quantify nonemphysematous lung volume (NELV; morphologically preserved parenchyma) and low-attenuation volume (emphysematous regions). Changes in lung volume and pulmonary function were expressed as percentages of preoperative values. Volumetric and functional outcomes were compared overall and by resected lobe.
RESULTS: NELV was positively correlated with forced expiratory volume in 1 second (FEV1). Planned resection NELV was significantly smaller in segmentectomy than in lobectomy (8.5% vs 19.2%, P < .001). Despite this difference, postoperative NELV (94.8% vs 93.5%, P = .545) and FEV1 (93.7% vs 92.7%, P = .483) were similar. Compensatory expansion occurred predominantly through NELV rather than low-attenuation volume. After segmentectomy, despite removal of 35.9% of the lobe volume, the operated lobe retained only 55.6%, indicating underexpansion. Right upper lobe segmentectomy was associated with better preserved FEV1 than lobectomy (98.7% vs 91.5%, P = .015), despite similar volumetric preservation.
CONCLUSIONS: Both procedures achieve similar outcomes through compensatory expansion, which explains the unexpectedly small functional differences observed in recent randomized trials.
METHODS: In this prospective observational study we analyzed 51 patients who underwent segmentectomy and 64 patients who underwent lobectomy. Three-dimensional computed tomography volumetry was performed preoperatively and at 12 months postoperatively to quantify nonemphysematous lung volume (NELV; morphologically preserved parenchyma) and low-attenuation volume (emphysematous regions). Changes in lung volume and pulmonary function were expressed as percentages of preoperative values. Volumetric and functional outcomes were compared overall and by resected lobe.
RESULTS: NELV was positively correlated with forced expiratory volume in 1 second (FEV1). Planned resection NELV was significantly smaller in segmentectomy than in lobectomy (8.5% vs 19.2%, P < .001). Despite this difference, postoperative NELV (94.8% vs 93.5%, P = .545) and FEV1 (93.7% vs 92.7%, P = .483) were similar. Compensatory expansion occurred predominantly through NELV rather than low-attenuation volume. After segmentectomy, despite removal of 35.9% of the lobe volume, the operated lobe retained only 55.6%, indicating underexpansion. Right upper lobe segmentectomy was associated with better preserved FEV1 than lobectomy (98.7% vs 91.5%, P = .015), despite similar volumetric preservation.
CONCLUSIONS: Both procedures achieve similar outcomes through compensatory expansion, which explains the unexpectedly small functional differences observed in recent randomized trials.