Eur J Cardiothorac Surg. 2023 Sep 15:ezad319. doi: 10.1093/ejcts/ezad319. Online ahead of print.
OBJECTIVES: Sublobar resection, including wedge resection and segmentectomy, is non-inferior to lobectomy in early-stage non-small cell lung cancer (NSCLC) treatment. We aimed to compare the risk of postoperative cognitive dysfunction (POCD) between sublobar resection and lobectomy.
METHODS: We conducted a prospective cohort study. Patients with sublobar resection or lobectomy were divided into sublobar group or lobar group, respectively. Cognition was assessed before and after surgery with Montreal Cognitive Assessment (MoCA) and Minimum Mental State Examination (MMSE) tests. POCD is defined as Z score of MoCA change≤-1.96. Propensity score matching (PSM) was performed to make demographics well-balanced between the two groups.
RESULTS: A total of 335 patients were enrolled. Both the postoperative 1-day POCD rate (sublobar 5.5% vs lobar 18.2%, P < 0.001) and the postoperative 1-month POCD rate (sublobar 7.9% vs lobar 21.8%, P < 0.001) were significantly lower in the sublobar group compared with lobar group, with demographics unbalanced between the two groups. In the 133 demographics-matched pairs obtained by propensity score matching (PSM), both the postoperative 1-day POCD rate (sublobar 5.3% vs lobar 17.3%, P = 0.005) and the postoperative 1-month POCD rate (sublobar 8.3% vs lobar 18.8%, P = 0.018) remained significantly lower in the sublobar group than lobar group. The incidences of postoperative 1-day (P = 0.109) and postoperative 1-month (P = 0.026) MMSE abnormity were also lower in the sublobar group than lobar group but only the latter was with statistical significance after PSM.
CONCLUSIONS: Sublobar resection has an advantage over lobectomy in preventing POCD. Our findings might be a reference for selecting the most suitable type of resection for NSCLC patients.