Assessment of emphysematous change and pulmonary function after lobectomy for lung cancer - quantitative 3D-CT analysis

Background: Lung volume reduction surgery (LVRS) in patients with severe chronic pulmonary emphysema (CPE) results in postoperative improvement in pulmonary function. Lobectomy in patients with lung cancer also has the same effect.Methods: One hundred fourteen patients underwent lobectomy for lung cancer from 2006 to 2011. Computed tomography (CT) and pulmonary function test (PFT) were performed preoperatively and six months to one half year after surgery. All CT examinations were performed using a 64-row multidetector CT scanner during a breath-hold at deep inspiration. Total lung volume (TLV), each lobe volume, and low attenuation area (LAA) were extracted from CT data of each patient.Results: TLV after upper lobectomy was increased signifi cantly compared with lower lobectomy (111.0 ± 18.9% vs 103.9 ± 16.1%;p=0.05). There was no relationship between lung volume change and preoperative LAA%. In contrast, LAA% change demonstrated a negative relationship with preoperative LAA% (r=0.4590). In the group defi ned as preoperative LAA% more than 20%, postoperative LAA% decreased signifi cantly (34.9 ± 13.9% to 32.8 ± 18.4%; p<0.01) and FEV1% predicted improved (70. 3 ± 9.7% to 75.3 ± 12.7%;p=0.03).Conclusions: The resected lobe region is more important than the resected lobe volume (RLV) and segment number in TLV change after lobectomy. Preoperative LAA% is a negative factor of LAA% change. Therefore patients with severe emphysematous lung are less likely to increase their postoperative LAA%. Lobectomy for patients with high LAA% provides improved FEV1 % predicted.