Relationship between functional preservation after segmentectomy and volume-reduction effects after lobectomy in stage I non-small cell lung cancer patients with emphysema.

摘要

OBJECTIVES: To evaluate whether functional preservation after segmentectomy has a greater advantage of pulmonary functions than volume-reduction effects after lobectomy in patients with emphysema with clinical T1N0 non-small cell lung cancer (NSCLC). PATIENTS AND METHODS: Between January 2000 and December 2006, 47 cases of lobectomy and 71 cases of segmentectomy were performed in patients with stage I NSCLC using intraoperative sentinel node identification. The postoperative change of the forced expiratory volume in 1 second (deltaFEV(1)) 6 months after segmentectomy was compared with that of 6 months after lobectomy. The difference in the deltaFEV(1) between after segmentectomy and after lobectomy was evaluated according to the ratio of the estimated postoperative FEV(1) to the predicted normal value of FEV(1) (%ppoFEV(1)). RESULTS: In 50 patients with the preoperative FEV(1)% less than 70%, there was no difference in the deltaFEV(1) between the segmentectomy group (n = 30) and the lobectomy group (n = 20). In 36 patients with emphysema diagnosed by high-resolution chest computed tomography, a negative linear correlation between the %ppoFEV(1) and the deltaFEV(1) was found in the lobectomy subgroup (n = 16, r = 0.508, p = 0.0012), but not in the segmentectomy subgroup (n = 20). When patients with emphysema had the %ppoFEV(1) more than or equal to 70%, the deltaFEV(1) had a tendency to be smaller in the segmentectomy subgroups than in the lobectomy subgroups. CONCLUSION: Segmentectomy should be considered in patients with cT1N0 NSCLC with a normal (>80%) predicted postoperative FEV(1). In patients with a %ppoFEV(1) under 70%, segmentectomy offers no functional advantages over lobectomy.