Left Upper Division Segmentectomy Compared with Lobectomy for Lung Expansion and Bronchus Tortuosity

Abstract

Background For patients with left upper lobe lesions, the functional benefit of left upper division segmentectomy over left upper lobectomy remains controversial. This study evaluated the clinical and functional outcomes after these two procedures.Methods This retrospective study included 135 patients with left upper lobe lesions (left upper lobectomy, 110; left upper division segmentectomy, 25). Propensity score matching was used to compare the two groups. Spirometry and computed tomography volume assessments were performed to evaluate bronchus angle and tortuosity. Short-term clinical respiratory symptoms were assessed via medical record reviews.Results Patients in both groups had similar preoperative characteristics, apart from tumor size (left upper division segmentectomy, 1.6 +/- 0.9 cm; left upper lobectomy, 2.8 +/- 1.7 cm; p = 0.002). After propensity score matching, both groups had similar preoperative spirometry and pathological results. The postoperative spirometry results were similar; however, the left upper division segmentectomy group had a significantly smaller decrease in left-side computed tomography lung volume compared with that in the left upper lobectomy group (left upper division segmentectomy, 323.6 +/- 521.4 mL; left upper lobectomy, 690.7 +/- 332.8 mL; p = 0.004). The left main bronchus-curvature index was higher in the left upper lobectomy group (left upper division segmentectomy, 1.074 +/- 0.035; left upper lobectomy, 1.097 +/- 0.036; p = 0.013), and more patients had persistent cough in the left upper lobectomy group (p = 0.001).Conclusions Left upper division segmentectomy may be a promising option for preventing marked bronchial angulation and decreasing postoperative persistent cough in patients with left upper lobe lung cancer.