Postoperative Lung Function Advantages in Pulmonary Segmentectomy for Early-Stage Lung Cancer

In early-stage lung cancer, lung function appears to be less compromised after segmentectomy than lobectomy, though the advantage seems modest. We aimed to re-assess postoperative lung function in surgical patients, with a particular focus on the diffusion capacity for carbon monoxide (DL). We evaluated all patients who underwent either lobectomy or segmentectomy for T1a-c lung cancer at our center between March 2016 and March 2023. From January to June 2024, patients who had undergone segmentectomy, along with a matched cohort of patients who had undergone lobectomy, were invited for a repeat lung function evaluation. Patients were matched 1:1 based on age, sex, surgical approach, year in which the procedure was performed, and tumor location. Lung function testing data including DL were then compared to preoperative measures. During the study period, 480 patients received a lobectomy, and 97 received a segmentectomy. Complete lung function evaluation for the study was available for 52 patients (26 matched pairs). The median time from lung resection to repeat spirometry was 35 months. A modest reduction of lung function measures was observed in the segmentectomy group. Conversely, all lung function measures, including DL, were significantly impaired in the lobectomy group. In early-stage lung cancer, patients who perform segmentectomy demonstrated better long-term lung function preservation compared to those who underwent lobectomy. Whenever feasible, segmentectomy should be considered the procedure of choice for early-stage lung cancer patients.