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Wang TW, Zhang Q, Cai Z, Xu Q, Lin J, Yeh H. Compensatory function change by segment-counting method in predicted postoperative pulmonary function at 1 year after surgery: systematic review and meta-analysis. BMJ Open Respir Res 2024; 11:e001855. [PMID: 39622586 PMCID: PMC11624756 DOI: 10.1136/bmjresp-2023-001855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 11/04/2024] [Indexed: 12/07/2024] Open
Abstract
BACKGROUND This systematic review aimed to assess the accuracy of the segment-counting method in predicting long-term pulmonary function recovery and investigate compensatory changes following different extents of lung resection. METHODS We included studies that measured forced expiratory volume at 1 s (FEV1) between 6 and 18 months postoperatively, comparing it to the predicted postoperative FEV1 (ppoFEV1) using the segment-counting method. The extent of lung resection was correlated with the ratio of postoperative FEV1 to ppoFEV1. A comprehensive search was conducted in Embase, MEDLINE and Web of Science using terms related to 'lung resection' and 'pulmonary function'. The final search was completed on 18 February 2022. Risk of bias was assessed using the Newcastle-Ottawa Scale. RESULTS 39 studies comprising 78 observation cohorts met the inclusion criteria. The analysis showed significant differences in pulmonary function in patients with ≥3 resected segments. Meta-regression indicated that the number of resected segments significantly impacted the postoperative FEV1/ppoFEV1 ratio, explaining 57% of the variance (R²=0. 57), with moderate heterogeneity (I²=61. 87%) across studies. Other variables, including patient age, body mass index, video-assisted thoracoscopic surgery use and tumour stage, did not show significant effects. DISCUSSION Limitations of the review included moderate heterogeneity between studies and potential selection bias related to the stage of cancer and lung volume reduction effects. The findings suggest that the extent of lung resection correlates with better-than-expected pulmonary function, potentially due to compensatory mechanisms. PROSPERO REGISTRATION NUMBER This review was registered on PROSPERO (CRD42021293608).
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Affiliation(s)
- Teng-Wei Wang
- The Third Hospital of Zhangzhou, Zhangzhou, Fujian, China
- Department of Thoracic, The University of Edinburgh School of Molecular Genetic and Population Health Sciences, Edinburgh, UK
| | - Qiang Zhang
- The Third Hospital of Zhangzhou, Zhangzhou, Fujian, China
- Fujian Medical University, Fuzhou, Fujian, China
| | - Zhihong Cai
- The Third Hospital of Zhangzhou, Zhangzhou, Fujian, China
- Department of Thoracic Surgery, Fujian Medical University, Fuzhou, Fujian, China
| | - Qinhong Xu
- The Third Hospital of Zhangzhou, Zhangzhou, Fujian, China
| | - Jinrong Lin
- Fujian Medical University, Fuzhou, Fujian, China
- Department of Thoracic Surgery, The Third Hospital of Zhangzhou, Zhangzhou, Fujian, China
| | - Huilong Yeh
- Department of Thoracic Surgery, The Third Hospital of Zhangzhou, Zhangzhou, Fujian, China
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Watanabe Y, Watanabe T, Hirama T, Murai S, Ueda K, Oishi H, Akiba M, Watanabe T, Suzuki T, Notsuda H, Onodera K, Togo T, Niikawa H, Noda M, Okada Y. Lobar graft evaluation in cadaveric lobar lung redo transplantation after living-donor lobar lung transplantation: a case report. Surg Case Rep 2024; 10:238. [PMID: 39441419 PMCID: PMC11499546 DOI: 10.1186/s40792-024-02046-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 10/11/2024] [Indexed: 10/25/2024] Open
Abstract
BACKGROUND Lung transplantation is a vital option for patients with end-stage lung disease. However, it faces a significant challenge due to the shortage of compatible donors, which particularly affects individuals with small chest cavities and pediatric patients. The novel approach of cadaveric lobar lung transplantation is a promising solution to alleviate the donor shortage crisis. Both the mid-term and long-term outcomes of lobar lung transplantation are comparable to those of standard lung transplantation. However, patients undergoing lobar lung transplantation reported a significantly higher rate of primary graft dysfunction compared to patients undergoing standard lung transplantation. Therefore, careful donor selection is critical to improve outcomes after lobar transplantation. However, no established method exists to evaluate each lung lobar graft of deceased donors. This case report describes a case of cadaveric lobar lung transplantation to overcome size mismatch and donor shortage, with particular emphasis on lobar graft evaluation. CASE PRESENTATION A 39-year-old woman with scleroderma-related respiratory failure was listed for deceased donor lung transplantation due to a rapidly progressing disease. Faced with a long waiting list and impending mortality, she underwent bilateral living-donor lobar lung transplantation donated by her relatives. Post-transplant complications included progressive pulmonary vein obstruction and pleural effusion, which ultimately required retransplantation. An oversized donor with pneumonia in the bilateral lower lobes was allocated. Lung ultrasound was used to evaluate each lung lobar graft during procurement. The right upper and middle lobes and left upper lobe were confirmed to be transplantable, and lobar lung redo transplantation was performed. The patient's post-transplant course was uneventful, and she was discharged home and returned to her daily activities. CONCLUSIONS This case highlights the clinical impact of cadaveric lobar lung transplantation as a feasible and effective strategy to overcome the shortage of donor lungs, especially in patients with small thoracic cavities. By establishing donor lung evaluation techniques and overcoming anatomical and logistical challenges, cadaveric lobar lung transplantation can significantly expand the donor pool and offer hope to those previously considered ineligible for transplantation.
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Affiliation(s)
- Yui Watanabe
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryomachi, Aobaku, Sendai, Miyagi, 980-8575, Japan.
| | - Tatsuaki Watanabe
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryomachi, Aobaku, Sendai, Miyagi, 980-8575, Japan
| | - Takashi Hirama
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryomachi, Aobaku, Sendai, Miyagi, 980-8575, Japan
- Organ Transplant Center, Tohoku University Hospital, Sendai, Japan
| | - Sho Murai
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryomachi, Aobaku, Sendai, Miyagi, 980-8575, Japan
| | - Kazunori Ueda
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryomachi, Aobaku, Sendai, Miyagi, 980-8575, Japan
| | - Hisashi Oishi
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryomachi, Aobaku, Sendai, Miyagi, 980-8575, Japan
| | - Miki Akiba
- Organ Transplant Center, Tohoku University Hospital, Sendai, Japan
| | - Toshikazu Watanabe
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryomachi, Aobaku, Sendai, Miyagi, 980-8575, Japan
| | - Takaya Suzuki
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryomachi, Aobaku, Sendai, Miyagi, 980-8575, Japan
| | - Hirotsugu Notsuda
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryomachi, Aobaku, Sendai, Miyagi, 980-8575, Japan
| | - Ken Onodera
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryomachi, Aobaku, Sendai, Miyagi, 980-8575, Japan
| | - Takeo Togo
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryomachi, Aobaku, Sendai, Miyagi, 980-8575, Japan
| | - Hiromichi Niikawa
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryomachi, Aobaku, Sendai, Miyagi, 980-8575, Japan
| | - Masafumi Noda
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryomachi, Aobaku, Sendai, Miyagi, 980-8575, Japan
| | - Yoshinori Okada
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryomachi, Aobaku, Sendai, Miyagi, 980-8575, Japan
- Organ Transplant Center, Tohoku University Hospital, Sendai, Japan
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Abe M, Osoegawa A, Karashima T, Takamori S, Takumi Y, Sugio K. An analysis of residual lung volume changes after segmentectomy based on three-dimensional computed tomography. J Thorac Dis 2024; 16:3553-3562. [PMID: 38983136 PMCID: PMC11228706 DOI: 10.21037/jtd-24-83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/26/2024] [Indexed: 07/11/2024]
Abstract
Background Based on the results of JCOG0802 and CALGB studies, segmentectomy has considered to be a standard procedure for early-stage non-small cell lung cancer (NSCLC). After lobectomy, the residual cavity is filled with mediastinal and diaphragmatic deviations, and compensatory volume changes are present in the residual lungs. In this study, we examined the efficacy of segmentectomy, a surgical procedure, by focusing on its impact on postoperative lung volume and function. Methods We enrolled 77 patients who underwent segmentectomy as their initial surgical procedure, excluding those with additional lung resections and those who lacked postoperative computed tomography imaging. The predicted residual volume (mL) was defined as the total lung volume before surgery minus the volume of the resected area. Using the predicted residual volume (mL) and postoperative total lung volume (mL), we calculated the rate of postoperative lung volume increase [(postoperative total lung volume/predicted residual volume) × 100] (%). We also classified 52 cases with a rate of postoperative lung volume increase of ≥100% into a compensatory group, while those with a rate of <100% were classified into a non-compensatory group. Results The average postoperative lung volume increase was 104.6% among 77 cases. Age ≥65 years, pack year index ≥27.5, ≥3 resected segments, and use of electrocautery for intersegmental plane division were significantly associated with compensatory group classification. In 20 compensatory cases with preoperative and postoperative pulmonary function tests, postoperative vital capacity and forced expiratory volume in one second values exceeded the preoperative predictions. This study further examined the areas responsible for postoperative compensatory lung volume increase. In the compensatory group, significant expansion was observed in the ipsilateral lobes, excluding the resected segment and contralateral lung, while no significant changes were noted in the volume of the lobe, including the resected segment. Conversely, the non-compensatory group showed a significant volume decrease in the resected lobe, but no significant increase in other areas. Conclusions This study emphasizes the importance of preserving lung segments in segmentectomy. The study demonstrates extensive compensatory volume changes in the ipsilateral lung and contralateral lung. There was no significant volume decrease in any residual segment. This underlines the potential of segmentectomy to maintain lung function and expand treatment options post-surgery. In addition, the compensated group included patients with a lower pack-year index and younger patients. These results suggest that postoperative compensatory lung expansion includes not only hyperinflation of the remaining lung, but also an increase in the functional lung parenchyma.
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Affiliation(s)
- Miyuki Abe
- Department of Thoracic and Breast Surgery, Oita University Faculty of Medicine, Yufu, Oita, Japan
| | - Atsushi Osoegawa
- Department of Thoracic and Breast Surgery, Oita University Faculty of Medicine, Yufu, Oita, Japan
| | - Takashi Karashima
- Department of Thoracic and Breast Surgery, Oita University Faculty of Medicine, Yufu, Oita, Japan
| | - Shinkichi Takamori
- Department of Thoracic and Breast Surgery, Oita University Faculty of Medicine, Yufu, Oita, Japan
| | - Yohei Takumi
- Department of Thoracic and Breast Surgery, Oita University Faculty of Medicine, Yufu, Oita, Japan
| | - Kenji Sugio
- Department of Thoracic and Breast Surgery, Oita University Faculty of Medicine, Yufu, Oita, Japan
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