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

Yoshimoto, Kentaro; Nomori, Hiroaki; Mori, Takeshi; Kobayashi, Hironori; Ohba, Yasuomi; Shibata, Hidekatsu; Tashiro, Kuniyuki; Shiraishi, Shinya; Kobayashi, Toshiaki

doi:10.1016/j.jtcvs.2008.10.028

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 137, Issue 5 , Pages 1200-1205, May 2009

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

Kentaro Yoshimoto, MD
- Department of Thoracic Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
Hiroaki Nomori, MD, PhD
- Department of Thoracic Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
- 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.
Takeshi Mori, MD, PhD
- Department of Thoracic Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
Hironori Kobayashi, MD, PhD
- Department of Thoracic Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
Yasuomi Ohba, MD
- Department of Thoracic Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
Hidekatsu Shibata, MD
- Department of Thoracic Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
Kuniyuki Tashiro, MD
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
Shinya Shiraishi, MD, PhD
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
Toshiaki Kobayashi, MD, PhD
- Department of Assistive Diagnostic Technology, National Cancer Center Hospital, Tokyo, Japan

Received 13 February 2008; received in revised form 1 October 2008; accepted 25 October 2008.

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.

CTSNet classification: 9, 10

Abbreviations and Acronyms: CT, computed tomography, DICOM, Digital Imaging and Communications in Medicine, FEV₁, forced expiratory volume in 1 second, LUL, left upper lobe, NSCLC, non–small cell lung cancer, RI, radioisotope, RLL, right lower lobe, RUL, right upper lobe, SPECT, single-photon-emission computed tomography