Purpose: Because both emphysema and lung cancer can arise from biological damage caused by cigarette smoking, we investigated if the development of emphysema is associated with the clinical features of smoker's lung cancer.

Absorbable mesh and fibrin glue applied to prevent alveolar air leakage contribute to reducing the length of chest tube drainage, length of hospitalization and the rate of pulmonary complications. This study investigated the feasibility of omitting chest tube drainage in selected patients undergoing thoracoscopic major lung resection. Intraoperative air leakages were sealed with fibrin glue and absorbable mesh in patients undergoing thoracoscopic major lung resection. The chest tube was removed just after tracheal extubation if no air leakages were detected in a suction-induced air leakage test, which is an original technique to confirm pneumostasis. Patients with bleeding tendency or extensive thoracic adhesions were excluded. Chest tube drainage was omitted in 29 (58%) of 50 eligible patients and was used in 21 (42%) on the basis of suction-induced air leakage test results. Male gender and compromised pulmonary function were significantly associated with the failure to omit chest tube drainage (both, P < 0.05). Regardless of omitting the chest tube drainage, there were no adverse events during hospitalization, such as subcutaneous emphysema, pneumothorax, pleural effusion or haemothorax, requiring subsequent drainage. Furthermore, there was no prolonged air leakage in any patients: The mean length of chest tube drainage was only 0.9 days. Omitting the chest tube drainage was associated with reduced pain on the day of the operation (P = 0.046). The refined strategy for pneumostasis allowed the omission of chest tube drainage in the majority of patients undergoing thoracoscopic major lung resection without increasing the risk of adverse events, which may contribute to a fast-track surgery.

Lung segmentectomy reduces the extent of resection required for lobectomy, but its resulting clinical benefits remain controversial. Forty patients who underwent segmentectomy for stage I lung cancer over a 5-year period were matched to 40 patients who underwent lobectomy, using nearest available matching method with the estimated propensity score. We compared the functional volume of the ipsilateral lung to be resected, the ipsilateral lung to be preserved and the contralateral lung before, and 6 months after the operation, between the groups. Functional lung volume was defined as the lung volume representing normal attenuation (-600 to -910 Hounsfield units (HUs)) on computed tomography. We also compared the volumetric parameters to the spirometric parameters in 42 other patients, who underwent major lung resection for stage I lung cancer. We removed 11.6% of the functional lung volume by segmentectomy and 24.5% by lobectomy (P<0.001). However, the loss of the functional lung volume after segmentectomy was only 8.3% and that after lobectomy was 9.2%: this difference was not significant (P=0.7). Both the ipsilateral residual lung and the contralateral lung increased in functional volume more extensively after lobectomy than after segmentectomy. Increased postoperative functional lung volume was significantly correlated with improvement in postoperative pulmonary function (R=0.6, P<0.001). Although lung segmentectomy can reduce the extent of lung resection, it may not contribute to preserving postoperative functional lung volume because lobectomy promotes postoperative expansion of the bilateral residual lung, which compensates postoperative pulmonary functional loss to a greater extent than segmentectomy.