Measured Postoperative DL,CO and FEV1 Frequently Exceed Segment-Count Predictions After Lung Cancer Surgery: A Retrospective Cohort Study
- 1Respiratory Research Unit PLUZ, Department of Internal and Respiratory Medicine, Zealand University Hospital Roskilde and Næstved, 4700 Næstved, Denmark
- 2Department of Thoracic Surgery, Odense University Hospital, 5000 Odense, Denmark
- 3Institute for Regional Health Research, University of Southern Denmark, 5230 Odense, Denmark
Abstract
Background: The segment count method (SCM) is standard for predicting post-operative pulmonary function tests (ppo-PFTs) in patients undergoing surgical resection for non-small cell lung cancer. Accurate prediction is pivotal for providing optimal treatment; however, earlier studies indicate that SCM underestimates ppo-PFTs. This study aimed to investigate whether this underestimation correlates with the specific lobe resected or pre-operative PFT values. Methods: This retrospective single-centre study evaluated patients who underwent surgical resection (wedge, segmentectomy, or lobectomy) for lung cancer. Clinical data were extracted from electronic medical files. PFTs (forced expiratory volume in the first second, FEV1, and diffusing capacity of the lungs for carbon monoxide, DL,CO) were performed before and within 1 year after surgery and reported as % predicted. The SCMs were calculated as the pre-operative PFTs minus the proportion related to the number of resected segments. Pre-operative DL,CO was categorised as 40–60%, 61–80%, and >80%. Results: In total, 117 patients were included (lobectomy n = 102, wedge resection n = 15). PFTs were preserved with wedge resection. In patients undergoing lobectomy, a >10% prediction error of SCM on DL,CO was observed in 74% (FEV1: 63%) and most often due to higher-than-predicted (DL,CO: 63%; FEV1: 52%) than lower-than-predicted PFT (DL,CO: 11%; FEV1: 11%). A higher BMI was significantly associated with lower-than-predicted PFTs. No association was found regarding the resected lobe. Notably, the prediction error of SCM increased with decreasing DL,CO: post-operative DL,CO was preserved in patients with pre-operative DL,CO 40–60%. Conclusions: The segment count method exhibits systematic imprecision that correlates inversely with baseline DL,CO levels. Further studies are needed to validate this finding and to investigate how the SCM can be refined to reduce prediction error, especially in patients with the lowest preoperative PFTs.
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BibTeX
@article{hartmeyer2026measured,
title = {{Measured Postoperative DL,CO and FEV1 Frequently Exceed Segment-Count Predictions After Lung Cancer Surgery: A Retrospective Cohort Study}},
author = {Helene Louise Hartmeyer and Cæcilie Kaas Bang and Gitte Alstrup and Morten Bendixen and Uffe Bodtger},
journal = {Cancers},
year = {2026},
month = nov,
doi = {10.3390/cancers18213576},
url = {https://www.mdpi.com/2072-6694/18/21/3576},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Measured Postoperative DL,CO and FEV1 Frequently Exceed Segment-Count Predictions After Lung Cancer Surgery: A Retrospective Cohort Study
AU - Helene Louise Hartmeyer
AU - Cæcilie Kaas Bang
AU - Gitte Alstrup
AU - Morten Bendixen
AU - Uffe Bodtger
PY - 2026
DA - 2026/11/06
JO - Cancers
DO - 10.3390/cancers18213576
UR - https://www.mdpi.com/2072-6694/18/21/3576
AB - Background: The segment count method (SCM) is standard for predicting post-operative pulmonary function tests (ppo-PFTs) in patients undergoing surgical resection for non-small cell lung cancer. Accurate prediction is pivotal for providing optimal treatment; however, earlier studies indicate that SCM underestimates ppo-PFTs. This study aimed to investigate whether this underestimation correlates with the specific lobe resected or pre-operative PFT values. Methods: This retrospective single-centre study evaluated patients who underwent surgical resection (wedge, segmentectomy, or lobectomy) for lung cancer. Clinical data were extracted from electronic medical files. PFTs (forced expiratory volume in the first second, FEV1, and diffusing capacity of the lungs for carbon monoxide, DL,CO) were performed before and within 1 year after surgery and reported as % predicted. The SCMs were calculated as the pre-operative PFTs minus the proportion related to the number of resected segments. Pre-operative DL,CO was categorised as 40–60%, 61–80%, and >80%. Results: In total, 117 patients were included (lobectomy n = 102, wedge resection n = 15). PFTs were preserved with wedge resection. In patients undergoing lobectomy, a >10% prediction error of SCM on DL,CO was observed in 74% (FEV1: 63%) and most often due to higher-than-predicted (DL,CO: 63%; FEV1: 52%) than lower-than-predicted PFT (DL,CO: 11%; FEV1: 11%). A higher BMI was significantly associated with lower-than-predicted PFTs. No association was found regarding the resected lobe. Notably, the prediction error of SCM increased with decreasing DL,CO: post-operative DL,CO was preserved in patients with pre-operative DL,CO 40–60%. Conclusions: The segment count method exhibits systematic imprecision that correlates inversely with baseline DL,CO levels. Further studies are needed to validate this finding and to investigate how the SCM can be refined to reduce prediction error, especially in patients with the lowest preoperative PFTs.
SN - 2072-6694
ER -