Relationship Between Functional Preservation after Segmentectomy and Volume-Reduction Effects after Lobectomy in Stage I Non-small Cell Lung Cancer Patients with Emphysema

ObjectivesTo 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 MethodsBetween 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 (°FEV1) 6 months after segmentectomy was compared with that of 6 months after lobectomy. The difference in the °FEV1 between after segmentectomy and after lobectomy was evaluated according to the ratio of the estimated postoperative FEV1 to the predicted normal value of FEV1 (%ppoFEV1).ResultsIn 50 patients with the preoperative FEV1% less than 70%, there was no difference in the °FEV1 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 %ppoFEV1 and the °FEV1 was found in the lobectomy subgroup (n = 16, r2 = 0.508, p = 0.0012), but not in the segmentectomy subgroup (n = 20). When patients with emphysema had the %ppoFEV1 more than or equal to 70%, the °FEV1 had a tendency to be smaller in the segmentectomy subgroups than in the lobectomy subgroups.ConclusionSegmentectomy should be considered in patients with cT1N0 NSCLC with a normal (>80%) predicted postoperative FEV1. In patients with a %ppoFEV1 under 70%, segmentectomy offers no functional advantages over lobectomy.