Sublobar resection reduces the risk of postoperative cognitive dysfunction compared with lobectomy

Nailiang Zang; Wei Shen; Shiyin Li; Liqi Chen; Qing Ai; Weimeng Huang; Lan Lan; Jun Liu; Wei Wang; Fei Cui; Jun Huang; Wenlong Shao; Xiaoyun Huang; Pingyi Xu; Jianxing He

doi:10.1093/ejcts/ezad319

Sublobar resection reduces the risk of postoperative cognitive dysfunction compared with lobectomy

Eur J Cardiothorac Surg. 2023 Nov 1;64(5):ezad319. doi: 10.1093/ejcts/ezad319.

Authors

Nailiang Zang^{1

2}, Wei Shen¹, Shiyin Li³, Liqi Chen³, Qing Ai¹, Weimeng Huang², Lan Lan⁴, Jun Liu¹, Wei Wang¹, Fei Cui¹, Jun Huang¹, Wenlong Shao¹, Xiaoyun Huang⁵, Pingyi Xu², Jianxing He¹

Affiliations

¹ Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, Guangzhou, China.
² Department of Neurology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
³ First School of Clinical Medicine, Guangzhou Medical University, Guangzhou, China.
⁴ Department of Anesthesiology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
⁵ Department of Neurology, Dongguan Songshan Lake Central Hospital, Dongguan, China.

Abstract

Objectives: Sublobar resection, including wedge resection and segmentectomy, is non-inferior to lobectomy in early-stage non-small cell lung cancer treatment. We aimed to compare the risk of postoperative cognitive dysfunction (POCD) between sublobar resection and lobectomy.

Methods: We conducted a prospective cohort study. Patients with sublobar resection or lobectomy were divided into the sublobar group or the lobar group, respectively. Cognition was assessed before and after surgery with Montreal Cognitive Assessment and Minimum Mental State Examination tests. POCD is defined as Z score of Montreal Cognitive Assessment change ≤-1.96. Propensity score matching (PSM) was performed to make demographics well-balanced between the 2 groups.

Results: A total of 335 patients were enrolled. Both the postoperative 1-day POCD rate (sublobar 5.5% vs lobar 18.2%, P < 0.001) and the postoperative 1-month POCD rate (sublobar 7.9% vs lobar 21.8%, P < 0.001) were significantly lower in the sublobar group compared with lobar group, with demographics unbalanced between the 2 groups. In the 133 demographics-matched pairs obtained by PSM, both the postoperative 1-day POCD rate (sublobar 5.3% vs lobar 17.3%, P = 0.005) and the postoperative 1-month POCD rate (sublobar 8.3% vs lobar 18.8%, P = 0.018) remained significantly lower in the sublobar group than in the lobar group. The incidences of postoperative 1-day (P = 0.109) and postoperative 1-month (P = 0.026) Minimum Mental State Examination abnormity were also lower in the sublobar group than in the lobar group but only the latter was with statistical significance after PSM.

Conclusions: Sublobar resection has an advantage over lobectomy in preventing POCD. Our findings might be a reference for selecting the most suitable type of resection for non-small-cell lung cancer patients.

Keywords: Lobectomy; Postoperative cognitive dysfunction; Propensity score matching; Sublobar resection.

MeSH terms

Carcinoma, Non-Small-Cell Lung* / surgery
Humans
Lung Neoplasms* / surgery
Neoplasm Staging
Pneumonectomy
Postoperative Cognitive Complications* / surgery
Prospective Studies
Retrospective Studies

Grants and funding

81870992/National Natural Science Foundation of China