Residual lung volume changes after thoracoscopic lobectomy and segmentectomy based on 3D-CT: a retrospective preliminary validation study

BACKGROUND: Three-dimensional CT enables quantitative assessment of lobar and lung volumes after anatomical resection, yet how postoperative compensation pattern relates to operation type remains unclear. METHODS: In this single-center retrospective cohort (n = 124), preoperative and postoperative 3D-CT volumes were quantified. The primary outcome was postoperative change in lung volume relative to preoperative baseline (Vpost - Vpre, %). Multivariable models adjusted for age, sex, BMI, and smoking; p values were FDR-adjusted. We also compared measured versus predicted percentages derived from preoperative ipsilateral lung and target-lobe volumes. RESULTS: Overall, postoperative total lung volume decreased modestly, with larger ipsilateral loss than contralateral change. After adjustment, left-lower lobe resections showed a greater ipsilateral volume decrease after lobectomy than after segmentectomy (FDR-significant), whereas differences in other lobes were small or uncertain after multiplicity control. Measured versus predicted comparisons indicated partial compensation on the operated side and near-preservation on the contralateral side. CONCLUSIONS: Findings highlight side-dependent compensation patterns and suggest that operation choice may influence ipsilateral volume loss in selected settings. Given the retrospective design and small surgical subgroups, these results are hypothesis-generating and warrant prospective validation and integration with oncologic considerations.