Segmental resection spares pulmonary function in patients with stage I lung cancer.
BACKGROUND
Segmental resection for stage I non-small cell lung cancer remains controversial. Reports suggest that segmentectomy confers no advantage in preserving lung function and compromises survival. This study was undertaken to assess the validity of those assertions.


METHODS
We retrospectively analyzed patients undergoing lobectomy (n = 147) or segmentectomy (n = 54) for stage I non-small cell lung cancer between March 1996 and June 2001. All patients were included in the survival analysis. Pulmonary function testing was obtained preoperatively and at 1 year and included forced vital capacity, forced expiratory volume in 1 second, maximum voluntary ventilation, diffusing capacity, and stair-stepper exercise. Patients with recurrent disease (lobectomy, n = 32; segmentectomy, n = 10) were excluded in the pulmonary function testing analysis to avoid the confounding variables of tumor or treatments.


RESULTS
Preoperative pulmonary function tests in segmentectomy patients were significantly reduced compared with lobectomy (forced expiratory volume in 1 second, 75.1% versus 55.3%; p < 0.001). At 1 year, lobectomy patients experienced significant declines in forced vital capacity (85.5% to 81.1%), forced expiratory volume in 1 second (75.1% to 66.7%), maximum voluntary ventilation (72.8% to 65.2%), and diffusing capacity (79.3% to 69.6%). In contrast, a decline in diffusing capacity was the only significant change seen after segmental resection. Oxygen saturations at rest and with exercise were maintained in both groups. Actuarial survival in both groups was similar (p = 0.406) with a 1-year survival of 95% for lobectomy and 92% for segmentectomy. Four-year survivals were 67% and 62%, respectively.


CONCLUSIONS
For patients with stage I non-small cell lung cancer, segmental resection offers preservation of pulmonary function compared with lobectomy and does not compromise survival. Segmentectomy should be considered whenever permitted by anatomic location.
Keenan
Robert J
RJ
Division of Thoracic Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania 15212, USA. rkennan@wpahs.org
Landreneau
Rodney J
RJ
Maley
Richard H
RH
Singh
Deepak
D
Macherey
Robin
R
Bartley
Susan
S
Santucci
Tibetha
T
D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D017079:Exercise Tolerance; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D015993:Life Tables; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods*; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome