title: Parenchymal preserving anatomic resections result in less pulmonary function loss in patients with Stage I non-small cell lung cancer.
abstract: BACKGROUND
  A suggested benefit of sublobar resection for stage I non-small cell lung cancer (NSCLC) compared to lobectomy is a relative preservation of pulmonary function. Very little objective data exist, however, supporting this supposition. We sought to evaluate the relative impact of both anatomic segmental and lobar resection on pulmonary function in patients with resected clinical stage I NSCLC.
  
  
  METHODS
  The records of 159 disease-free patients who underwent anatomic segmentectomy (n = 89) and lobectomy (n = 70) for the treatment of stage I NSCLC with pre- and postoperative pulmonary function tests performed between 6 to 36 months after resection were retrospectively reviewed. Changes in forced expiratory volume in one second (FEV1) and diffusion capacity of carbon monoxide (DLCO) were analyzed based upon the number of anatomic pulmonary segments removed: 1-2 segments (n = 77) or 3-5 segments (n = 82).
  
  
  RESULTS
  Preoperative pulmonary function was worse in the lesser resection cohort (1-2 segments) compared to the greater resection group (3-5 segments) (FEV1(%predicted): 79% vs. 85%, p = 0.038; DLCO(%predicted): 63% vs. 73%, p = 0.010). A greater decline in FEV1 was noted in patients undergoing resection of 3-5 segments (FEV1 (observed): 0.1 L vs. 0.3 L, p = 0.003; and FEV1 (% predicted): 4.3% vs. 8.2%, p = 0.055). Changes in DLCO followed this same trend (DLCO(observed): 1.3 vs. 2.4 mL/min/mmHg, p = 0.015; and DLCO(% predicted): 3.6% vs. 5.9%, p = 0.280).
  
  
  CONCLUSIONS
  Parenchymal-sparing resections resulted in better preservation of pulmonary function at a median of one year, suggesting a long-term functional benefit with small anatomic segmental resections (1-2 segments). Prospective studies to evaluate measurable functional changes, as well as quality of life, between segmentectomy and lobectomy with a larger patient cohort appear justified.
authors.affiliation: Division of Cardiothoracic Surgery; Department of Surgery, University of Wisconsin, 600 Highland Avenue, H4/318 Clinical Sciences Center, Madison, WI, 53792, USA. macke@surgery.wisc.edu.
authors.forename: Ryan A
authors.initials: RA
authors.lastname: Macke
authors.affiliation: Division of Thoracic and Foregut Surgery; Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA. schuchertmj@upmc.edu.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Schuchert
authors.affiliation: Division of Thoracic and Foregut Surgery; Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA. odelldd@upmc.edu.
authors.forename: David D
authors.initials: DD
authors.lastname: Odell
authors.affiliation: Division of Thoracic and Foregut Surgery; Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA. wilsondo@upmc.edu.
authors.forename: David O
authors.initials: DO
authors.lastname: Wilson
authors.affiliation: Division of Thoracic and Foregut Surgery; Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA. luketichjd@upmc.edu.
authors.forename: James D
authors.initials: JD
authors.lastname: Luketich
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery; Alleghany Health Network, Pittsburgh, PA, USA. rlandren@wpahs.org.
authors.forename: Rodney J
authors.initials: RJ
authors.lastname: Landreneau
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008175:Lung Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods*; D011184:Postoperative Period; D057234:Preoperative Period; D012189:Retrospective Studies