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Robert J. Keenan
Rodney J. Landreneau
Richard H. Maley, Jr
Deepak Singh
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Ann Thorac Surg 2004;78:228-233
© 2004 The Society of Thoracic Surgeons

Original article: general thoracic

Segmental resection spares pulmonary function in patients with stage I lung cancer

Robert J. Keenan, MDa*, Rodney J. Landreneau, MDa, Richard H. Maley, Jr, MDa, Deepak Singh, MDa, Robin Macherey, RNa, Susan Bartley, RNa, Tibetha Santucci, RNa

a Division of Thoracic Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA

Accepted for publication January 22, 2004.

* Address reprint requests to Dr Keenan, Division of Thoracic Surgery, Allegheny General Hospital, 14th Floor, South Tower, 320 East North Ave, Pittsburgh, PA 15212, USA
e-mail: rkeenan{at}wpahs.org

Presented at the Thirty-ninth Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 31–Feb 2, 2003.

BACKGROUND: Segmental resection for stage I non–small cell lung cancer remains controversial. Reports suggest that segmentectomy confers no advantage in preserving lung function and compromises survival. This study was undertaken to assess the validity of those assertions.

METHODS: We retrospectively analyzed patients undergoing lobectomy (n = 147) or segmentectomy (n = 54) for stage I non–small cell lung cancer between March 1996 and June 2001. All patients were included in the survival analysis. Pulmonary function testing was obtained preoperatively and at 1 year and included forced vital capacity, forced expiratory volume in 1 second, maximum voluntary ventilation, diffusing capacity, and stair-stepper exercise. Patients with recurrent disease (lobectomy, n = 32; segmentectomy, n = 10) were excluded in the pulmonary function testing analysis to avoid the confounding variables of tumor or treatments.

RESULTS: Preoperative pulmonary function tests in segmentectomy patients were significantly reduced compared with lobectomy (forced expiratory volume in 1 second, 75.1% versus 55.3%; p < 0.001). At 1 year, lobectomy patients experienced significant declines in forced vital capacity (85.5% to 81.1%), forced expiratory volume in 1 second (75.1% to 66.7%), maximum voluntary ventilation (72.8% to 65.2%), and diffusing capacity (79.3% to 69.6%). In contrast, a decline in diffusing capacity was the only significant change seen after segmental resection. Oxygen saturations at rest and with exercise were maintained in both groups. Actuarial survival in both groups was similar (p = 0.406) with a 1-year survival of 95% for lobectomy and 92% for segmentectomy. Four-year survivals were 67% and 62%, respectively.

CONCLUSIONS: For patients with stage I non–small cell lung cancer, segmental resection offers preservation of pulmonary function compared with lobectomy and does not compromise survival. Segmentectomy should be considered whenever permitted by anatomic location.




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