Abe Miyuki, Osoegawa Atsushi, Karashima Takashi, Takamori Shinkichi, Takumi Yohei, Sugio Kenji
Department of Thoracic and Breast Surgery, Oita University Faculty of Medicine, Yufu, Oita, Japan.
J Thorac Dis. 2024 Jun 30;16(6):3553-3562. doi: 10.21037/jtd-24-83. Epub 2024 Jun 17.
Based on the results of JCOG0802 and CALGB studies, segmentectomy has considered to be a standard procedure for early-stage non-small cell lung cancer (NSCLC). After lobectomy, the residual cavity is filled with mediastinal and diaphragmatic deviations, and compensatory volume changes are present in the residual lungs. In this study, we examined the efficacy of segmentectomy, a surgical procedure, by focusing on its impact on postoperative lung volume and function.
We enrolled 77 patients who underwent segmentectomy as their initial surgical procedure, excluding those with additional lung resections and those who lacked postoperative computed tomography imaging. The predicted residual volume (mL) was defined as the total lung volume before surgery minus the volume of the resected area. Using the predicted residual volume (mL) and postoperative total lung volume (mL), we calculated the rate of postoperative lung volume increase [(postoperative total lung volume/predicted residual volume) × 100] (%). We also classified 52 cases with a rate of postoperative lung volume increase of ≥100% into a compensatory group, while those with a rate of <100% were classified into a non-compensatory group.
The average postoperative lung volume increase was 104.6% among 77 cases. Age ≥65 years, pack year index ≥27.5, ≥3 resected segments, and use of electrocautery for intersegmental plane division were significantly associated with compensatory group classification. In 20 compensatory cases with preoperative and postoperative pulmonary function tests, postoperative vital capacity and forced expiratory volume in one second values exceeded the preoperative predictions. This study further examined the areas responsible for postoperative compensatory lung volume increase. In the compensatory group, significant expansion was observed in the ipsilateral lobes, excluding the resected segment and contralateral lung, while no significant changes were noted in the volume of the lobe, including the resected segment. Conversely, the non-compensatory group showed a significant volume decrease in the resected lobe, but no significant increase in other areas.
This study emphasizes the importance of preserving lung segments in segmentectomy. The study demonstrates extensive compensatory volume changes in the ipsilateral lung and contralateral lung. There was no significant volume decrease in any residual segment. This underlines the potential of segmentectomy to maintain lung function and expand treatment options post-surgery. In addition, the compensated group included patients with a lower pack-year index and younger patients. These results suggest that postoperative compensatory lung expansion includes not only hyperinflation of the remaining lung, but also an increase in the functional lung parenchyma.
基于JCOG0802和CALGB研究结果，肺段切除术已被视为早期非小细胞肺癌（NSCLC）的标准手术。肺叶切除术后，残余腔隙会出现纵隔和膈肌移位，残余肺会出现代偿性容积变化。在本研究中，我们通过关注肺段切除术对术后肺容积和功能的影响来检验其疗效。
我们纳入了77例行肺段切除术作为初始手术的患者，排除了那些接受了额外肺切除术的患者以及那些缺乏术后计算机断层扫描成像的患者。预计残余容积（mL）定义为术前总肺容积减去切除区域的容积。利用预计残余容积（mL）和术后总肺容积（mL），我们计算了术后肺容积增加率[（术后总肺容积/预计残余容积）×100]（%）。我们还将52例术后肺容积增加率≥100%的病例分为代偿组，而将增加率<100%的病例分为非代偿组。
77例患者术后肺容积平均增加104.6%。年龄≥65岁、吸烟包年指数≥27.5、切除段数≥3段以及在段间平面分离时使用电灼与代偿组分类显著相关。在20例进行了术前和术后肺功能测试的代偿病例中，术后肺活量和一秒用力呼气量值超过了术前预测值。本研究进一步检查了术后肺代偿性容积增加的责任区域。在代偿组中，观察到同侧肺叶（不包括切除段和对侧肺）有显著扩张，而包括切除段的肺叶容积无显著变化。相反，非代偿组切除的肺叶容积显著减小，但其他区域无显著增加。
本研究强调了在肺段切除术中保留肺段的重要性。该研究表明同侧肺和对侧肺存在广泛的代偿性容积变化。任何残余段均无显著容积减小。这突出了肺段切除术在维持肺功能和扩大术后治疗选择方面的潜力。此外，代偿组包括吸烟包年指数较低的患者和较年轻的患者。这些结果表明，术后肺代偿性扩张不仅包括残余肺的过度充气，还包括功能性肺实质的增加。
