title: Cardiomegaly Is a Significant Predictor of Postoperative Atelectasis following Left Upper Superior Segmentectomy.
abstract: BACKGROUND
  Segmentectomy is becoming more common since many lung cancers are small when found. Left upper superior segmentectomy (LUSS) is the most popular procedure for segmentectomy. Atelectasis is a common postoperative complication following segmentectomy. In this study, we sought to better understand atelectasis of the lingular segment following LUSS.
  
  
  METHODS
  Among 265 patients who underwent segmentectomy of the lung at our institute between February 2008 and August 2012, 60 patients who underwent LUSS were investigated retrospectively. An intersegmental plane was created using a stapler in 41 and by cautery in 19. The relationships between atelectasis of the lingular segment and clinical factors were analyzed by multivariate analysis. The clinical factors examined included body mass index, preoperative cardio/thoracic dimension ratio (CTR), preoperative forced expiratory volume in 1 second (FEV1), the method used to make an intersegmental plane, the interval of thoracic drainage, and the degree of lobulation.
  
  
  RESULTS
  Atelectasis of the lingular segment was seen in nine (15.0%) patients. Preoperative CTR predicted atelectasis of the lingular segment (p = 0.004). FEV1 was preserved in 73.8% of patients with atelectasis of the lingular segment and in 86.8% of the controls. This difference was significant (p = 0.027). Atelectasis of the middle lobe following RUL was seen in 10/238 (4.2%) within the same period.
  
  
  CONCLUSIONS
  Preoperative CTR was related to atelectasis of the lingular segment. One of the advantages of segmentectomy is that it enables the postoperative preservation of respiratory function. However, in patients with cardiomegaly, respiratory function following LUSS may be preserved less than expected.
authors.affiliation: Department of General Thoracic Surgery, Juntendo University, Tokyo, Japan.
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Miyasaka
authors.affiliation: Department of General Thoracic Surgery, Juntendo University, Tokyo, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Suzuki
authors.affiliation: Department of General Thoracic Surgery, Juntendo University, Tokyo, Japan.
authors.forename: Shiaki
authors.initials: S
authors.lastname: Oh
authors.affiliation: Department of General Thoracic Surgery, Juntendo University, Tokyo, Japan.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Takamochi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D006332:Cardiomegaly / Q000150:complications* / Q000209:etiology; D002425:Cautery / Q000009:adverse effects; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects* / Q000379:methods; D011184:Postoperative Period; D001261:Pulmonary Atelectasis / Q000209:etiology*; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012307:Risk Factors; D017792:Surgical Stapling / Q000009:adverse effects; D058106:Wound Closure Techniques