What is the benefit of preserving the superior segment in anatomical thoracoscopic resections of the lower lobe?

Seung Keun Yoon; Jae Kwang Yun; Sehoon Choi; Hyeong Ryul Kim; Yong-Hee Kim; Dong Kwan Kim; Seung-Il Park; Geun Dong Lee

doi:10.21037/jtd-23-791

What is the benefit of preserving the superior segment in anatomical thoracoscopic resections of the lower lobe?

J Thorac Dis. 2023 Nov 30;15(11):6009-6018. doi: 10.21037/jtd-23-791. Epub 2023 Nov 8.

Authors

Seung Keun Yoon¹, Jae Kwang Yun², Sehoon Choi², Hyeong Ryul Kim², Yong-Hee Kim², Dong Kwan Kim², Seung-Il Park², Geun Dong Lee²

Affiliations

¹ Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
² Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

Abstract

Background: The beneficial effect of preserved superior segment (S6) after common basal segmentectomy remains unknown. We aimed to evaluate the effect of preserved superior segment on lung volume and function.

Methods: Among 671 segmentectomies and 2,249 lobectomies for clinical stage IA lung cancer between 2004 and 2020, 48 patients who received thoracoscopic common basal segmentectomy were included and compared with 96 patients who received thoracoscopic lower lobectomy after propensity score matching. The variables analyzed were age, sex, comorbidity, smoking history, preoperative forced expiratory volume in one second (FEV1), clinical T stage, histology, and tumor location. Lung volume was assessed using a three-dimensional (3D) computed tomography (CT)-based volumetric method.

Results: There were no significant differences between common basal segmentectomy (segmentectomy group) and lower lobectomy (lobectomy group) (4,183.8±1,114.9 versus 3,850.7±1,132.1 mL; P=0.10) in terms of preoperative CT-measured total lung volume. At the immediate postoperative median follow-up period (6.4 months), the reduced percentage of CT-measured total lung volume in the segmentectomy group was significantly larger than that in the lobectomy group (-16.2% versus -6.5%; P=0.004). The percentage of CT-measured contralateral lung volume expansion in the segmentectomy group was significantly smaller than that in the lobectomy group (-0.7% versus +8.9%; P=0.006). At the last median follow-up period (43.1 months), the reduced percentage of CT-measured total lung volume in the segmentectomy group remained larger than that in the lobectomy group (-13.0% versus -3.0%; P=0.01). The reduced percentage of postoperative FEV1 in the segmentectomy group did not differ from that in the lobectomy group (-9.9% versus -11.5%, P=0.63).

Conclusions: Preserving the superior segment might not provide beneficial effect on the preservation of postoperative lung volume and function after common basal segmentectomy compared with lower lobectomy.

Keywords: Superior segment; common basal segmentectomy; lobectomy.