Background
Methods
Measurements
Statistical analysis
Results
Patient characteristics
Type of surgery | P-value | ||||
---|---|---|---|---|---|
Overall (N = 620) | Wedge resection/segmentectomy | Lobectomy | Bilobectomy/pneumonectomy | ||
Characteristic | (n = 120, 19.4%) | (n = 477, 76.9%) | (n = 23, 3.7%) | ||
Age, years | 61.2 (9.0) | 59.6 (9.2) | 61.5 (9.0) | 63.2 (7.8) | 0.07 |
Sex, male | 350 (56.5) | 63 (52.5) | 268 (56.2) | 19 (82.6) | 0.03 |
Body mass index, kg/m2 | 24.0 ± 2.9 | ||||
Smoking status, ever smoker | 319 (51.5) | 54 (45.0) | 247 (51.8) | 18 (78.3) | 0.01 |
Comorbidities | |||||
COPDa | 140 (22.8) | 26 (21.7) | 106 (22.2) | 8 (34.8) | 0.22 |
Hypertension | 211 (34.0) | 31 (25.8) | 170 (35.6) | 10 (43.5) | 0.08 |
Diabetes mellitus | 92 (14.8) | 14 (11.7) | 73 (15.3) | 5 (21.7) | 0.39 |
Cardiovascular disease | 16 (2.6) | 4 (3.3) | 12 (2.5) | 0 | 0.64 |
Cell type | < 0.01 | ||||
Adenocarcinoma | 513 (82.7) | 111 (92.5) | 394 (82.6) | 8 (34.8) | |
Squamous cell | 87 (14.0) | 6 (5.0) | 67 (14.1) | 14 (60.9) | |
Others | 20 (3.2) | 3 (2.5) | 16 (3.4) | 1 (4.4) | |
Tumor size, cm | 2.7 (1.5) | 1.7 (0.7) | 2.9 (1.5) | 4.1 (1.9) | < 0.01 |
Pathologic stage | < 0.01 | ||||
I | 451 (72.7) | 116 (96.7) | 330 (69.2) | 5 (21.7) | |
II | 96 (15.5) | 2 (1.7) | 83 (17.4) | 11 (47.8) | |
III | 70 (3.0) | 2 (1.7) | 62 (13.0) | 6 (26.1) | |
IV | 3 (3.2) | 0 | 2 (0.4) | 1 (4.4) | |
Surgical approach (VATS, %) | 490 (79.0) | 112 (93.3) | 373 (78.2) | 5 (21.7) | < 0.01 |
PPC, yes | 49 (7.9) | 10 (8.3) | 36 (7.6) | 3 (13.0) | 0.62 |
Adjuvant treatment, yes | 149 (24.0) | 3 (2.5) | 131 (27.5) | 15 (65.2) | < 0.01 |
Changes in pulmonary function
Before surgery | 2 weeks after surgery | 6 months after surgery | 1 year after surgery | |||
---|---|---|---|---|---|---|
Overall | ||||||
FVC (mL) | ||||||
Adjusted mean (SE) | 3600.3 (21.2) | 2721.4 (21.5) | 3137.7 (23.1) | 3268.8 (24.8) | ||
Change from baseline (95% CI)a | Reference | − 879 (− 910.3, − 847.6) | − 462.6 (− 495.4, − 429.8) | − 331.6 (− 365.4, − 297.7) | ||
FVC, % pred | ||||||
Adjusted mean (SE) | 93.2 (0.5) | 70.9 (0.5) | 81.6 (0.5) | 85.2 (0.6) | ||
Change from baseline (95% CI)a | Reference | − 23.3 (− 24.1, − 22.5) | − 12.3 (− 13.2, − 11.4) | − 8.5 (− 9.4, − 7.6) | ||
FEV1 (mL) | ||||||
Adjusted mean (SE) | 2647.0 (16.7) | 2033.1 (16.9) | 2318.3 (17.9) | 2395.2 (18.9) | ||
Change from baseline (95% CI)a | Reference | − 613.9 (− 636.2, − 591.6) | − 328.7 (− 352.0, − 305.3) | − 251.7 (− 275.7, − 227.8) | ||
FEV1, % pred | ||||||
Adjusted mean (SE) | 90.4 (0.5) | 69.8 (0.5) | 79.6 (0.6) | 82.6 (0.6) | ||
Change from baseline (95% CI)a | Reference | − 20.6 (− 21.3, − 19.9) | − 10.7 (− 11.5, − 10.0) | − 7.8 (− 8.6, − 7.0) | ||
DLco, ml/min/mmHg | ||||||
Adjusted mean (SE) | 18.6 (0.1) | 15.8 (0.1) | 15.9 (0.1) | |||
Change from baseline (95% CI)a | Reference | − 4.0 (− 5.1, − 2.9) | − 3.3 (− 4.4, − 2.2) | |||
DLco, % pred | ||||||
Adjusted mean (SE) | 90.5 (0.6) | 77.5 (0.6) | 78.3 (0.6) | |||
Change from baseline (95% CI)a | Reference | − 13.0 (− 14.0, − 12.0) | − 12.2 (− 13.2, − 11.2) | |||
Type of surgery | ||||||
FVC (mL) | ||||||
Adjusted mean (SE) | ||||||
Wedge resection/segmentectomy | 3648.0 (49.2) | 2977.9 (50) | 3403.6 (52.8) | 3483.3 (56.4) | ||
Lobectomy | 3596.2 (24.2) | 2678.7 (24.6) | 3102.5 (26.3) | 3242.0 (28.1) | ||
Bilobectomy/pneumonectomy | 3394.4 (116.5) | 2198.8 (119.8) | 2394.8 (125.6) | 2624.3 (136.5) | ||
P-values | 0.15 | < 0.01 | < 0.01 | < 0.01 | ||
Change from baseline (95% CI)a | ||||||
Wedge resection/segmentectomy | Reference | − 670.1 (− 739, − 601.2) | − 244.4 (− 315.4, − 173.4) | − 164.7 (− 237.9, − 91.5) | ||
Lobectomy | Reference | − 917.4 (− 952.1, − 882.7) | − 493.6 (− 530.2, − 457.0) | − 354.2 (− 391.8, − 316.6) | ||
Bilobectomy/pneumonectomy | Reference | − 1195.6 (− 1358.3, 1032.9) | − 999.6 (− 1165.9, − 833.3) | − 770.1 (− 949.4, − 590.8) | ||
P for interaction | < 0.01 | < 0.01 | < 0.01 | |||
FVC, % predicted | ||||||
Adjusted mean (SE) | ||||||
Wedge resection/segmentectomy | 93.4 (1.1) | 76.4 (1.1) | 87.1 (1.2) | 89.3 (1.3) | ||
Lobectomy | 93.3 (0.5) | 70.0 (0.5) | 81.0 (0.6) | 84.7 (0.6) | ||
Bilobectomy/pneumonectomy | 88.9 (2.6) | 60.2 (2.7) | 65.6 (2.8) | 70.8 (3.1) | ||
P-values | 0.25 | < 0.01 | < 0.01 | < 0.01 | ||
Change from baseline (95% CI)a | ||||||
Wedge resection/segmentectomy | Reference | − 17.0 (− 18.6, − 15.4) | − 6.4 (− 8.1, − 4.7) | − 4.1 (− 5.9, − 2.3) | ||
Lobectomy | Reference | − 23.3 (− 24.1, − 22.5) | − 12.3 (− 13.2, − 11.4) | − 8.5 (− 9.4, − 7.6) | ||
Bilobectomy/pneumonectomy | Reference | − 28.8 (− 32.6, − 24.9) | − 23.3 (− 27.3, − 19.3) | − 18.2 (− 22.5, − 13.9) | ||
P for interaction | < 0.01 | < 0.01 | < 0.01 | |||
FEV1 (mL) | ||||||
Adjusted mean (SE) | ||||||
Wedge resection/segmentectomy | 2677.9 (38.9) | 2206.5 (39.4) | 2485.5 (41.1) | 2537.4 (43.4) | ||
Lobectomy | 2647.2 (19.1) | 2004.8 (19.3) | 2295.1 (20.4) | 2376.9 (21.6) | ||
Bilobectomy/pneumonectomy | 2449.9 (92.1) | 1669.6 (94.3) | 1872.2 (97.9) | 1981.1 (104.7) | ||
P-values | 0.08 | < 0.01 | < 0.01 | < 0.01 | ||
Change from baseline (95% CI)a | ||||||
Wedge resection/segmentectomy | Reference | − 471.3 (− 520.9, − 421.8) | − 192.4 (− 243.4, − 141.4) | − 140.5 (− 192.8, − 88.2) | ||
Lobectomy | Reference | − 642.4 (− 667.4, − 617.5) | − 352.1 (− 378.4, − 325.8) | − 270.3 (− 297.2, − 243.5) | ||
Bilobectomy/pneumonectomy | Reference | − 780.3 (− 897.4, − 663.3) | − 577.7 (− 697.2, − 458.2) | − 468.8 (− 596.9, − 340.7) | ||
P for interaction | < 0.01 | < 0.01 | < 0.01 | |||
FEV1, % pred | ||||||
Adjusted mean (SE) | ||||||
Wedge resection/segmentectomy | 90.3 (1.2) | 74.8 (1.2) | 84.2 (1.3) | 86.3 (1.3) | ||
Lobectomy | 90.6 (0.6) | 68.9 (0.6) | 79.0 (0.6) | 82.2 (0.7) | ||
Bilobectomy/pneumonectomy | 85.2 (2.9) | 61.3 (3) | 66.8 (3) | 70.8 (3.2) | ||
P-values | 0.19 | < 0.01 | < 0.01 | < 0.01 | ||
Change from baseline (95% CI)a | ||||||
Wedge resection/segmentectomy | Reference | − 15.5 (− 17.1, − 13.8) | − 6.0 (− 7.7, − 4.3) | − 4.0 (− 5.8, − 2.1) | ||
Lobectomy | Reference | − 21.7 (− 22.6, − 20.9) | − 11.6 (− 12.5, − 10.7) | − 8.4 (− 9.4, − 7.5) | ||
Bilobectomy/pneumonectomy | Reference | − 24.0 (− 27.8, − 20.1) | − 18.4 (− 22.4, − 14.5) | − 14.4 (− 18.9, − 10) | ||
P for interaction | < 0.01 | < 0.01 | < 0.01 | |||
DLco, ml/min/mmHg | ||||||
Adjusted mean (SE) | ||||||
Wedge resection/segmentectomy | 18.4 (0.3) | 16.9 (0.3) | 16.7 (0.3) | |||
Lobectomy | 18.6 (0.1) | 15.6 (0.2) | 15.7 (0.1) | |||
Bilobectomy/pneumonectomy | 18.4 (0.7) | 14.4 (0.8) | 15.0 (0.7) | |||
P-values | 0.81 | < 0.01 | < 0.01 | |||
Change from baseline (95% CI)a | ||||||
Wedge resection/segmentectomy | Reference | − 1.5 (− 1.9, − 1.1) | − 1.7 (− 2.2, − 1.3) | |||
Lobectomy | Reference | − 3.0 (− 3.2, − 2.8) | − 2.9 (− 3.1, − 2.6) | |||
Bilobectomy/pneumonectomy | Reference | − 4.0 (− 5.1, − 2.9) | − 3.3 (− 4.4, − 2.2) | |||
P-values | < 0.01 | < 0.01 | ||||
DLco, % pred | ||||||
Adjusted mean (SE) | ||||||
Wedge resection/segmentectomy | 88.4 (1.3) | 81.2 (1.3) | 81.1 (1.4) | |||
Lobectomy | 91.0 (0.6) | 76.6 (0.7) | 77.6 (0.7) | |||
Bilobectomy/pneumonectomy | 90.1 (3.1) | 71.7 (3.4) | 75.4 (3.3) | |||
P-values | 0.21 | < 0.01 | 0.05 | |||
Change from baseline (95% CI)a | ||||||
Wedge resection/segmentectomy | Reference | − 7.1 (− 0.3, − 5.1) | − 7.3 (− 9.5, − 5.1) | |||
Lobectomy | Reference | − 14.4 (− 15.5, − 13.3) | − 13.4 (− 14.5, − 12.3) | |||
Bilobectomy/pneumonectomy | Reference | − 18.5 (− 23.8, − 13.1) | − 14.8 (− 20.2, − 9.4) | |||
P-values | < 0.01 | < 0.01 |
Before surgery | 2 weeks after surgery | 6 months after surgery | 1 year after surgery | |||
---|---|---|---|---|---|---|
Overall | ||||||
FEV1/FVC (%) | ||||||
Adjusted mean (SE) | 73.9 (0.3) | 75.1 (0.3) | 74.2 (0.3) | 73.6 (0.4) | ||
Change from baseline (95% CI)a | Reference | 1.3 (0.8, 1.7) | 0.4 (− 0.1, 0.9) | − 0.3 (− 0.8, 0.3) | ||
Obstructive pattern | ||||||
Adjusted proportion (SE) | 20.2 (1.5) | 20.4 (1.6) | 22.1 (1.6) | 25.8 (1.8) | ||
Odds ratio (95% CI)a | Reference | 1.0 (0.8, 1.1) | 1.0 (0.8, 1.2) | 1.2 (1.0, 1.3) | ||
Restrictive pattern | ||||||
Adjusted proportion (SE) | 7.4 (1.0) | 57.8 (1.9) | 33.1 (1.9) | 23.5 (1.8) | ||
Odds ratio (95% CI)a | Reference | 7.8 (6.0, 10.3) | 4.5 (3.4, 5.8) | 3.2 (2.4, 4.1) | ||
Type of surgery | ||||||
FEV1/FVC (%) | ||||||
Adjusted mean (SE) | ||||||
Wedge resection/segmentectomy | 73.6 (0.7) | 74.7 (0.7) | 73.4 (0.8) | 73.1 (0.8) | ||
Lobectomy | 74.0 (0.3) | 75.3 (0.4) | 74.3 (0.4) | 73.6 (0.4) | ||
Pneumonectomy/bilobectomy | 73.0 (1.7) | 74.6 (1.7) | 77.4 (1.8) | 75.5 (2.0) | ||
P-values | 0.79 | 0.73 | 0.12 | 0.55 | ||
Obstructive pattern | ||||||
Adjusted proportion (SE) | ||||||
Wedge resection/segmentectomy | 25.1 (3.8) | 22.4 (3.7) | 24.4 (3.9) | 27.2 (4) | ||
Lobectomy | 21.7 (1.7) | 21.7 (1.7) | 22.3 (1.8) | 25.8 (1.9) | ||
Bilobectomy/pneumonectomy | 23.0 (7.3) | 17.3 (6.7) | 13.5 (6.1) | 22.0 (7.7) | ||
P-values | 0.69 | 0.83 | 0.44 | 0.85 | ||
Restrictive pattern | ||||||
Adjusted proportion (SE) | ||||||
Wedge resection/segmentectomy | 4.9 (2) | 44.6 (4.5) | 15.5 (3.4) | 9.1 (2.8) | ||
Lobectomy | 6.8 (1.1) | 60.0 (2.2) | 35.8 (2.3) | 25.7 (2.1) | ||
Bilobectomy/pneumonectomy | 26.7 (9) | 72.3 (10.4) | 67.0 (10.9) | 48.2 (11.7) | ||
P-values | < 0.01 | < 0.01 | < 0.01 | < 0.01 |
Changes of PROs
Before surgery | 2 weeks after surgery | 6 months after surgery | 1 year after surgery | |||
---|---|---|---|---|---|---|
Overall | ||||||
mMRC dyspnea scale | ||||||
Adjusted mean (SE) | 0.25 (0.03) | 1.05 (0.03) | 0.53 (0.03) | 0.42 (0.03) | ||
Change from baseline (95% CI)a | Reference | 0.81 (0.74, 0.88) | 0.28 (0.21, 0.36) | 0.17 (0.10, 0.24) | ||
CAT total score | ||||||
Adjusted mean (SE) | 5.97 (0.23) | 12.77 (0.24) | 7.29 (0.25) | 6.22 (0.25) | ||
Change from baseline (95% CI)a | Reference | 6.79 (6.3, 7.29) | 1.32 (0.8, 1.84) | 0.24 (− 0.29, 0.77) | ||
Type of surgery | ||||||
mMRC dyspnea scale | ||||||
Adjusted mean (SE) | ||||||
Wedge resection/segmentectomy | 0.27 (0.06) | 0.82 (0.06) | 0.36 (0.07) | 0.34 (0.07) | ||
Lobectomy | 0.24 (0.03) | 1.09 (0.03) | 0.55 (0.03) | 0.42 (0.03) | ||
Bilobectomy/pneumonectomy | 0.13 (0.14) | 1.44 (0.15) | 0.83 (0.16) | 0.65 (0.17) | ||
P-values | 0.67 | < 0.01 | < 0.01 | 0.22 | ||
Change from baseline (95% CI)a | ||||||
Wedge resection/segmentectomy | Reference | 0.55 (0.39, 0.71) | 0.10 (− 0.06, 0.26) | 0.07 (− 0.09, 0.24) | ||
Lobectomy | Reference | 0.85 (0.76, 0.93) | 0.30 (0.22, 0.39) | 0.17 (0.09, 0.26) | ||
Bilobectomy/pneumonectomy | Reference | 1.31 (0.95, 1.67) | 0.78 (0.41, 1.16) | 0.52 (0.13, 0.91) | ||
P for interaction | < 0.01 | < 0.01 | 0.11 | |||
CAT total score | ||||||
Adjusted mean (SE) | ||||||
Wedge resection/segmentectomy | 6.08 (0.54) | 11.61 (0.55) | 6.55 (0.55) | 5.78 (0.54) | ||
Lobectomy | 5.83 (0.27) | 13.09 (0.28) | 7.42 (0.28) | 6.28 (0.27) | ||
Bilobectomy/pneumonectomy | 8.48 (1.27) | 12.55 (1.3) | 8.75 (1.34) | 6.96 (1.31) | ||
P-values | 0.12 | 0.02 | 0.12 | 0.2 | ||
Change from baselinea | ||||||
Wedge resection/segmentectomy | Reference | 5.54 (4.43, 6.64) | 0.47 (− 0.67, 1.61) | − 0.30 (− 1.48, 0.89) | ||
Lobectomy | Reference | 7.26 (6.69, 7.83) | 1.59 (1.00, 2.18) | 0.45 (− 0.15, 1.05) | ||
Bilobectomy/pneumonectomy | Reference | 4.07 (1.53, 6.61) | 0.27 (-2.46, 3.00) | − 1.52 (− 4.31, 1.27) | ||
P for interaction | < 0.01 | 0.17 | 0.25 |
Before surgery | 2 weeks after surgery | 6 months after surgery | 1 year after surgery | ||
---|---|---|---|---|---|
Cough frequency | |||||
Adjusted mean (SE) | 0.82 (0.05) | 2.00 (0.05) | 0.96 (0.06) | 0.68 (0.06) | |
Change from baseline (95% CI)a | Reference | 1.18 (1.05, 1.31) | 0.15 (0.01, 0.28) | − 0.14 (− 0.27, 0.00) | |
Amount of phlegm | |||||
Adjusted mean (SE) | 0.83 (0.05) | 0.89 (0.05) | 0.77 (0.05) | 0.67 (0.05) | |
Change from baseline (95% CI)a | Reference | 0.05 (− 0.06, 0.16) | − 0.06 (− 0.18, 0.05) | − 0.16 (− 0.27, − 0.04) | |
Chest tightness | |||||
Adjusted mean (SE) | 0.50 (0.05) | 1.30 (0.05) | 0.50 (0.05) | 0.47 (0.05) | |
Change from baseline (95% CI)a | Reference | 0.8 (0.68, 0.91) | − 0.01 (− 0.12, 0.11) | − 0.04 (− 0.15, 0.08) | |
Breathlessness walking upstairs | |||||
Adjusted mean (SE) | 1.28 (0.06) | 2.85 (0.06) | 1.97 (0.06) | 1.79 (0.07) | |
Change from baseline (95% CI)a | Reference | 1.57 (1.43, 1.71) | 0.70 (0.55, 0.84) | 0.52 (0.37, 0.66) | |
Home activities limited | |||||
Adjusted mean (SE) | 0.05 (0.03) | 0.64 (0.03) | 0.16 (0.04) | 0.10 (0.04) | |
Change from baseline (95% CI)a | Reference | 0.59 (0.51, 0.68) | 0.12 (0.03, 0.21) | 0.06 (− 0.04, 0.15) | |
Not confident leaving home | |||||
Adjusted mean (SE) | 0.08 (0.04) | 1.26 (0.04) | 0.23 (0.05) | 0.15 (0.05) | |
Change from baseline (95% CI)a | Reference | 1.19 (1.07, 1.3) | 0.16 (0.04, 0.28) | 0.08 (− 0.04, 0.2) | |
Sleep disturbance | |||||
Adjusted mean (SE) | 0.96 (0.06) | 1.56 (0.07) | 0.86 (0.07) | 0.86 (0.07) | |
Change from baseline (95% CI)a | Reference | 0.60 (0.44, 0.75) | − 0.10 (− 0.26, 0.06) | − 0.42 (− 0.58, − 0.25) | |
Lack of energy | |||||
Adjusted mean (SE) | 1.49 (0.06) | 2.50 (0.06) | 1.84 (0.06) | 1.80 (0.06) | |
Change from baseline (95% CI)a | Reference | 1.00 (0.87, 1.14) | 0.35 (0.21, 0.49) | 0.31 (0.17, 0.46) |