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J Thorac Cardiovasc Surg 2009;137:1200-1205
© 2009 The American Association for Thoracic Surgery

General Thoracic Surgery

Quantification of the impact of segmentectomy on pulmonary function by perfusion single-photon-emission computed tomography and multidetector computed tomography

^a Department of Thoracic Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
^b Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
^c Department of Assistive Diagnostic Technology, National Cancer Center Hospital, Tokyo, Japan

Received for publication February 13, 2008; revisions received October 1, 2008; accepted for publication October 25, 2008.

^_* Address for reprints: Hiroaki Nomori, MD, PhD, Department of Thoracic Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan. (Email: hnomori{at}qk9.so-net.ne.jp).

Objective: The impact of segmentectomy for preservation of pulmonary function was quantified by using a co-registered perfusion single-photon-emission computed tomography and multidetector computed tomography (SPECT/CT).

Methods: Pulmonary function tests and perfusion SPECT/CT were conducted before and after segmentectomy in 56 patients. Actual values of forced expiratory volume in 1 second (FEV₁) after segmentectomy were compared with the FEV₁ after virtual lobectomy, which was calculated by SPECT/CT. The preoperative and postoperative FEV₁ of each lobe that had undergone segmentectomy was measured by SPECT/CT.

Results: The mean percent of FEV₁ preserved after segmentectomy was significantly higher than the value after virtual lobectomy (88% ± 9% vs 77% ± 7%; P < .001). Whereas the mean value of the preoperative FEV₁ of each lobe that was undergoing segmentectomy was 0.51±0.21 L, segmentectomy could preserve 41% ± 24% of it. The FEV₁ of each lobe after the resection of more than three segments (n = 4) was preserved in 17% ± 12% of the preoperative values, which was significantly less than 49% ± 23% and 35% ± 22% after the resection of one (n = 29) and two (n = 23) segments (P = .02 and .08, respectively). The FEV₁ of the left upper lobe after the upper division segmentectomy (n = 8) was preserved in 21% ± 11% of the preoperative values, which was significantly less than 35% ± 12% after the lingular segmentectomy (n = 7) (P = .03).

Conclusion: Segmentectomy can preserve the pulmonary function more significantly than lobectomy, except for the resection of more than three segments or the left upper division segmentectomy.