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. 2025 Aug 10;15(8):1265.
doi: 10.3390/life15081265.

Morphological and Functional Analysis of Residual Lung After Pneumonectomy in Lung Cancer Surgery via 3D-CT Method

Omer Topaloglu  1 , Rıza Aktepe  2 , Kubra Nur Kilic  3 , Sami Karapolat  3 , Ali Yavuz Uzun  4 , Elvan Senturk Topaloglu  5 , Atila Turkyilmaz  3 , Serkan Ozden  3 , Aziz Gumus  5 , Celal Tekinbas  3 , Hasan Turut  1
Affiliations

Morphological and Functional Analysis of Residual Lung After Pneumonectomy in Lung Cancer Surgery via 3D-CT Method

Omer Topaloglu et al. Life (Basel). .

Abstract

Background: Pneumonectomy is a major surgical option for non-small cell lung cancer (NSCLC). This study evaluates the predictive value of three-dimensional computed tomography (3D-CT)-based lung volume analysis for postoperative function and explores its potential role in preoperative planning, risk assessment, and surgical decision-making. Methods: We evaluated 59 NSCLC patients who underwent pneumonectomy. Pre- and 12-month postoperative spirometry results were compared with anatomical and 3D-CT-based predictions. Residual lung expansion was calculated, and patients were grouped by a 3D-CT-derived volume ratio of ≥1.2 or <1.2. Results: There was a significant correlation between 3D-CT-based predicted FVC and FEV1 and postoperative spirometric values (p < 0.001). The mean residual lung volume expansion ratio was 1.23. Patients with a ratio ≥1.2 had significantly higher postoperative FVC (p = 0.028). Lung expansion was observed in 81.4% of cases. Predicted postoperative FVC (p = 0.023) and FEV1 (p = 0.013) were significantly higher in patients with left pneumonectomy compared to right. Conclusions: 3D-CT-based lung volume calculation reliably predicts postoperative function and matches conventional methods. Contralateral lung expansion positively affects respiratory outcomes. Additionally, 3D-CT analysis supports preoperative planning and risk assessment, contributing to more accurate diagnosis and surgical decisions in NSCLC management.

Keywords: 3D computed tomography (3D-CT); lung volume calculation; pneumonectomy; pulmonary function test; residual lung expansion.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Figure 1
Figure 1
Flowchart of participant inclusion and exclusion.
Figure 2
Figure 2
Preoperative 3D−CT volume measurement and visualization of both lungs in a patient scheduled for pneumonectomy.
Figure 3
Figure 3
Measurement and visualization of the volume of the residual lung by 3D−CT volume measurement method with the control thorax CT of a patient who underwent pneumonectomy 1 year later.
Figure 4
Figure 4
Scatterplot showing the relationship between estimated FVC values calculated based on 3D-CT lung volume and FVC values measured by postoperative spirometry.
Figure 5
Figure 5
Scatterplot showing the relationship between estimated FEV1 values calculated according to 3D-CT lung volume and FEV1 values measured with postoperative spirometer.
Figure 6
Figure 6
Scatterplot graph showing the relationship between estimated FVC values calculated according to the number of segments and FVC values measured by postoperative spirometer.
Figure 7
Figure 7
Scatterplot graph showing the relationship between estimated FEV1 values calculated according to the number of segments and FEV1 values measured by postoperative spirometer.
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