Lobectomy resulted in a significantly greater mean increase in the pulmonary artery to aorta ratio from baseline to 3 years post-operatively compared to sublobar resection (difference 0.065).
Observational (n=301)
No
Does lobectomy increase the pulmonary artery to aorta ratio compared to sublobar resection in patients with stage 0-I lung cancer?
Lobectomy is associated with a significantly greater increase in the PA/A ratio compared to sublobar resection, suggesting higher pulmonary-vascular loading and potential risk for right-heart strain.
Effect estimate: Difference 0.065 (95% CI 0.049-0.081)
p-value: p=<0.01
The pulmonary artery diameter-to-aortic diameter (PA/A) ratio on computed tomography correlates with PA pressure and is a simple tool for estimating the load on the right side of the heart. The purpose of this study was to investigate the change in the PA/A ratio in patients following lung resection according to the specific procedure used. Patients with pathological stage 0–I lung cancer who underwent lobectomy or sublobar resection between 2018 and 2020 were included in this study. The PA/A ratios were measured pre-operatively and at 1 and 3 years post-operatively (POY1 and POY3). Changes over time and factors associated with an increased PA/A ratio were analysed. Of 301 eligible patients, 210 underwent lobectomy and 91 underwent sublobar resection (35 segmentectomies and 56 wedge resections). Age, sex, body mass index, and smoking status were similar between the groups. Cardiac comorbidity and pathological stage 0 disease were more common in the sublobar resection group versus the lobectomy group (20.9% vs. 11.0%, 29.7% vs. 6.2%). Compared with the sublobar resection group, the lobectomy group showed a significantly higher ratio at POY3 (0.823 ± 0.131 vs. 0.786 ± 0.128) and a greater mean increase from baseline to POY1 (difference between groups: 0.039, 95% confidence interval CI 0.023–0.05) and from baseline to POY3 (0.065, 95% CI 0.049–0.08). On multivariable analysis, lobectomy independently predicted a postoperative PA/A ratio increase (odds ratio 7.98, 95% CI 3.85–16.6). Compared with sublobar resection, lobectomy is associated with a significantly larger rise in the PA/A ratio, suggesting greater pulmonary-vascular loading after more extensive parenchymal removal. Surveillance of the PA/A ratios may help identify patients at risk of right-heart strain.
Nakai et al. (Fri,) conducted a observational in Pathological stage 0–I lung cancer (n=301). Lobectomy vs. Sublobar resection was evaluated on Mean increase in PA/A ratio from baseline to 3 years post-operatively (Difference 0.065, 95% CI 0.049-0.081, p=<0.01). Lobectomy resulted in a significantly greater mean increase in the pulmonary artery to aorta ratio from baseline to 3 years post-operatively compared to sublobar resection (difference 0.065).