The impact of segmentectomy versus lobectomy on pulmonary function in patients with non-small-cell lung cancer: a meta-analysis

Objective Segmentectomy has been reported as an alternative to lobectomy for small-sized NSCLC without detriment to survival. The long-term benefits of segmentectomy over lobectomy on pulmonary function have not been firmly established. This meta-analysis aims to compare postoperative changes in pulmonary function in NSCLC patients undergoing segmentectomy or lobectomy. Methods Medline, Embase, Web of Science and Scopus were searched through March 2021. Statistical comparisons were made when appropriate. Results Fourteen studies (2412 participants) out of 324 citations were included in this study. All selected studies were high quality, as indicated by the Newcastle-Ottawa scale for assessing the risk of bias. Clinical outcomes were compared between segmentectomy and lobectomy. Delta FEV1 [10 studies, P < 0.01, WMD = 0.40 (0.29, 0.51)], Delta FVC [4 studies, P < 0.01, WMD = 0.16 (0.07, 0.24)], Delta FVC% [4 studies, P < 0.01, WMD = 4.05 (2.32, 5.79)], Delta FEV1/FVC [2 studies, P < 0.01, WMD = 1.99 (0.90, 3.08)], and Delta DLCO [3 studies, P < 0.01, WMD = 1.30 (0.69, 1.90)] were significantly lower in the segmentectomy group than in the lobectomy group. Subgroup analysis showed that in stage IA patients, the Delta FEV1% [3 studies, P < 0.01, WMD = 0.26 (0.07, 0.46)] was significantly lower in the segmentectomy group. The Delta DLCO% and Delta MVV% were incomparable. Conclusion Segmentectomy preserves more lung function than lobectomy. There were significantly smaller decreases in FEV1, FVC, FVC%, FEV1/FVC and DLCO in the segmentectomy group than in the lobectomy group.