ASO Author Reflection: Position of the Complex Segmentectomy on Postoperative Pulmonary Function

Abstract

As aggressive screening programs result in a diagnosis of early-stage non-small cell lung cancer (NSCLC) for a growing number of patients, segmentectomy currently is selected more frequently than before. To date, segmentectomy has been evaluated as a single surgical procedure. However, the authors believe it needs to be divided further according to surgical procedure and condition of the intersegmental plane, specifically into the categories of simple segmentectomy and complex segmentectomy. However, few studies have evaluated the postoperative pulmonary function of complex segmentectomy. The current study analyzed data from 580 patients who underwent surgical resection between 2007 and 2018. The patients were divided into complex segmentectomy (n = 135), simple segmentectomy (n = 83), wedge resection (n = 89), and lobectomy (n = 273) groups. Functional testing included forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1.0), and predicted diffusing capacity of the lung for carbon monoxide (%DLCO), measured preoperatively and then 12 months after surgery. During the postoperative course, the complex segmentectomy and simple segmentectomy groups showed a comparable course of pulmonary function (postoperativeto-preoperative ratio) in FVC (complex segmentectomy, 0.90 vs simple segmentectomy, 0.91; P = 0.46), FEV1.0 (complex segmentectomy, 0.90 vs simple segmentectomy, 0.91; P = 0.34), and %DLCO (complex segmentectomy, 0.93 vs simple segmentectomy, 0.90; P = 0.15). A similar trend was observed even when the number of resected segments was aligned. The complex segmentectomy group significantly preserved pulmonary function compared with lobectomy [FVC: complex segmentectomy, 0.90 vs lobectomy, 0.86 (P = 0.017); FEV1: complex segmentectomy, 0.90 vs lobectomy, 0.86 (P = 0.010); %DLCO: complex segmentectomy, 0.93 vs lobectomy, 0.88 (P = 0.0043)], and a similar trend was observed even when the analysis was restricted to lung diseases in the right upper lobe. On the other hand, when complex segmentectomy was compared with wedge resection, complex segmentectomy showed a trend that was more disadvantageous than wedge resection, but this difference was not significant [FVC: complex segmentectomy, 0.90 vs wedge, 0.92 (P = 0.19); FEV1: complex segmentectomy, 0.90 vs wedge, 0.91 (P = 0.40); %DLCO: complex segmentectomy, 0.93 vs wedge, 0.93 (P = 0.96)]. The study suggests that complex segmentectomy and simple segmentectomy have comparable postoperative pulmonary functions. In addition, complex segmentectomy could preserve pulmonary function significantly compared with lobectomy and in this study did not result in significant loss compared with wedge resection. We recently showed that cancer control was better in segmentectomy than in wedge resection. The current study showed no significant difference in pulmonary function between complex segmentectomy and wedge resection. The authors of this report consider that segmentectomy should be performed even for complex type Society of Surgical Oncology 2021