Quantification of the impact of segmentectomy on pulmonary function by perfusion single-photon-emission computed tomography and multidetector computed tomography.
OBJECTIVE
The impact of segmentectomy for preservation of pulmonary function was quantified by using a co-registered perfusion single-photon-emission computed tomography and multidetector computed tomography (SPECT/CT).


METHODS
Pulmonary function tests and perfusion SPECT/CT were conducted before and after segmentectomy in 56 patients. Actual values of forced expiratory volume in 1 second (FEV(1)) after segmentectomy were compared with the FEV(1) after virtual lobectomy, which was calculated by SPECT/CT. The preoperative and postoperative FEV(1) of each lobe that had undergone segmentectomy was measured by SPECT/CT.


RESULTS
The mean percent of FEV(1) preserved after segmentectomy was significantly higher than the value after virtual lobectomy (88% +/- 9% vs 77% +/- 7%; P < .001). Whereas the mean value of the preoperative FEV(1) of each lobe that was undergoing segmentectomy was 0.51+/-0.21 L, segmentectomy could preserve 41% +/- 24% of it. The FEV(1) of each lobe after the resection of more than three segments (n = 4) was preserved in 17% +/- 12% of the preoperative values, which was significantly less than 49% +/- 23% and 35% +/- 22% after the resection of one (n = 29) and two (n = 23) segments (P = .02 and .08, respectively). The FEV(1) of the left upper lobe after the upper division segmentectomy (n = 8) was preserved in 21% +/- 11% of the preoperative values, which was significantly less than 35% +/- 12% after the lingular segmentectomy (n = 7) (P = .03).


CONCLUSIONS
Segmentectomy can preserve the pulmonary function more significantly than lobectomy, except for the resection of more than three segments or the left upper division segmentectomy.
Yoshimoto
Kentaro
K
Department of Thoracic Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Nomori
Hiroaki
H
Mori
Takeshi
T
Kobayashi
Hironori
H
Ohba
Yasuomi
Y
Shibata
Hidekatsu
H
Tashiro
Kuniyuki
K
Shiraishi
Shinya
S
Kobayashi
Toshiaki
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods*; D011182:Postoperative Care; D011300:Preoperative Care; D012129:Respiratory Function Tests; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014797:Vital Capacity