Thoracoscopic left S1 + 2 segmentectomy as a good resolution for preserving pulmonary function. (4th August 2020) - Tane, Shinya
Abstract: OBJECTIVES: Segmentectomies such as S 1 + 2, S 1 + 2+3 and S 4 + 5 segmentectomy are used to treat patients with non-small-cell lung cancer (NSCLC) in the left upper lobe. However, the preservable lung volume and changes after such segmentectomies remain unknown. We compared the residual pulmonary function after thoracoscopic segmentectomy or lobectomy in the left upper lobe and examined the efficacy of S 1 + 2 segmentectomy regarding postoperative pulmonary function. METHODS: Patients with left upper lobe NSCLC who underwent thoracoscopic segmentectomy or lobectomy were included. Spirometry and computed tomography were performed before and 6 months after resection, and the ipsilateral preserved lobe volume was calculated using 3-dimensional computer tomography. The percentage of postoperative/preoperative forced expiratory volume in 1 s and actual/predicted regional forced expiratory volume in 1 s (preservation rate) in the residual lobe were compared. RESULTS: Eighty-eight patients underwent lobectomy and 70 patients underwent segmentectomy (23 S 1 + 2, 35 S 1 + 2+3 and 12 S 4 + 5 segmentectomies). The percentage of postoperative/preoperative forced expiratory volume in 1 s was 97 in S 1 + 2, 82 in S 1 + 2+3, 86 in S 4 + 5 segmentectomy and 73 in left upper lobectomy, indicating that segmentectomy could be a meaningful approach to preserve pulmonary function. The preservation rate was 83% in S 1 + 2 and 62% in S 1 + 2+3 segmentectomy and was significantly higher in S 1 + 2 than in S 1 + 2+3 segmentectomy ( P < 0.001). CONCLUSIONS: Postoperative pulmonary function and the preservable lung volume of the residual lobe after thoracoscopic S 1 + 2 segmentectomy were well-preserved among other segmentectomies and lobectomy. Thoracoscopic S 1 + 2 segmentectomy is a good alternative for preserving postoperative function.