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Comparative Study
. 2011 Feb 20:6:17.
doi: 10.1186/1749-8090-6-17.

Combined subsegmentectomy: postoperative pulmonary function compared to multiple segmental resection

Kentaro Yoshimoto  1 , Hiroaki Nomori, Takeshi Mori, Yasuomi Ohba, Kenji Shiraishi, Koei Ikeda
Affiliations
Comparative Study

Combined subsegmentectomy: postoperative pulmonary function compared to multiple segmental resection

Kentaro Yoshimoto et al. J Cardiothorac Surg. .

Abstract

Background: For small peripheral c-T1N0M0 non-small cell lung cancers involving multiple segments, we have conducted a resection of subsegments belonging to different segments, i.e. combined subsegmentectomy (CSS), to avoid resection of multiple segments or lobectomy. Tumor size, location of tumor, and forced expiratory volume in 1 second (FEV1) of each preserved lobe were compared among the CSS, resection of single segment, and that of multiple segments.

Methods: FEV1 of each preserved lobe were examined in 17 patients who underwent CSS, 56 who underwent resection of single segment, and 41 who underwent resection of multiple segments, by measuring pulmonary function and lung-perfusion single-photon-emission computed tomography and computed tomography before and after surgery.

Results: Tumor size in the CSS was significantly smaller than that in the resection of multiple segments (1.4±0.5 vs. 2.0±0.8 cm, p=0.002). Tumors in the CSS were located in the right upper lobe more frequently than those in the resection of multiple segments (53% vs. 5%, p<0.001). Postoperative of FEV1 of each lobe after the CSS was higher than that after the resection of multiple segments (0.3±0.2 vs. 0.2±0.2 l, p=0.07). Mean FEV1 of each preserved lobe per subsegment after CSS was significantly higher than that after resection of multiple segments (0.05±0.03 vs. 0.03±0.02 l, p=0.02). There was no significant difference of these factors between the CSS and resection of single segment.

Conclusions: The CSS is effective for preserving pulmonary function of each lobe, especially for small sized lung cancer involving multiple segments in the right upper lobe, which has fewer segments than other lobes.

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Figures

Figure 1
Figure 1
Sagittal image of CT. The tumor located between the right subsegment 2b and 3a.
Figure 2
Figure 2
Images of before and after segmentectomy. (a) Coronal image of CT before surgery, showing a lung cancer (arrow) in the segment 2b of right upper lobe. (b) Coronal image of the perfusion SPECT/CT of the right upper lobe before operation. (c) Coronal image of the perfusion SPECT/CT of the remaining right upper lobe after the resection of S2b and S3a.
Figure 3
Figure 3
Forced expiratory volume in 1 second examined by pulmonary function tests before and after surgery.
Figure 4
Figure 4
Forced expiratory volume in 1 second of each lobe after surgery.
Figure 5
Figure 5
Preserved forced expiratory volume in 1 second of each lobe per subsegment after surgery.
See this image and copyright information in PMC

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