title: Combined subsegmentectomy: postoperative pulmonary function compared to multiple segmental resection.
abstract: BACKGROUND
  For small peripheral c-T1N0M0 non-small cell lung cancers involving multiple segments, we have conducted a resection of subsegments belonging to different segments, i.e. combined subsegmentectomy (CSS), to avoid resection of multiple segments or lobectomy. Tumor size, location of tumor, and forced expiratory volume in 1 second (FEV1) of each preserved lobe were compared among the CSS, resection of single segment, and that of multiple segments.
  
  
  METHODS
  FEV1 of each preserved lobe were examined in 17 patients who underwent CSS, 56 who underwent resection of single segment, and 41 who underwent resection of multiple segments, by measuring pulmonary function and lung-perfusion single-photon-emission computed tomography and computed tomography before and after surgery.
  
  
  RESULTS
  Tumor size in the CSS was significantly smaller than that in the resection of multiple segments (1.4±0.5 vs. 2.0±0.8 cm, p=0.002). Tumors in the CSS were located in the right upper lobe more frequently than those in the resection of multiple segments (53% vs. 5%, p<0.001). Postoperative of FEV1 of each lobe after the CSS was higher than that after the resection of multiple segments (0.3±0.2 vs. 0.2±0.2 l, p=0.07). Mean FEV1 of each preserved lobe per subsegment after CSS was significantly higher than that after resection of multiple segments (0.05±0.03 vs. 0.03±0.02 l, p=0.02). There was no significant difference of these factors between the CSS and resection of single segment.
  
  
  CONCLUSIONS
  The CSS is effective for preserving pulmonary function of each lobe, especially for small sized lung cancer involving multiple segments in the right upper lobe, which has fewer segments than other lobes.
authors.affiliation: Department of Thoracic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Yoshimoto
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nomori
authors.forename: Takeshi
authors.initials: T
authors.lastname: Mori
authors.forename: Yasuomi
authors.initials: Y
authors.lastname: Ohba
authors.forename: Kenji
authors.initials: K
authors.lastname: Shiraishi
authors.forename: Koei
authors.initials: K
authors.lastname: Ikeda
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005540:Forced Expiratory Flow Rates / Q000502:physiology*; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods*; D011184:Postoperative Period; D012129:Respiratory Function Tests / Q000379:methods*; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D016896:Treatment Outcome