Impact of Postoperative Prolonged Air Leakage on Long-Term Pulmonary Function after Lobectomy for Lung Cancer.

Background: This study aimed to evaluate the long-term impact of postoperative prolonged air leak (PAL) on pulmonary function.

Methods: We enrolled 1,316 patients with pathologic stage I-III lung cancer who underwent lobectomy. The cohort was divided into 2 groups: those who experienced PAL (n=55) and those who did not (n=1,261). Propensity score matching was conducted at a 1:4 ratio, resulting in 49 patients in the PAL group and 189 in the non-PAL group. Changes in pulmonary function were compared among preoperative, 6-month postoperative, and 12-month postoperative measurements between the 2 groups.

Results: The variables used for propensity score matching included age, sex, smoking history, body mass index, baseline pulmonary function, pathologic stage, and surgical approach. All standardized mean differences were less than 0.1. Six months postoperatively, the PAL group showed a greater reduction in both forced expiratory volume in 1 second (FEV₁) (-13.0% vs. -10.0%, p=0.041) and forced vital capacity (FVC) (-15.0% vs. -9.0%, p<0.001) than the non-PAL group. In cases of upper lobectomy, there were no significant differences in FEV₁ changes between the PAL and non-PAL groups at both 6 and 12 months. However, in lower lobectomy, the PAL group demonstrated a more pronounced decrease in FEV₁ (-14.0% vs. -11.0%, p=0.057) and FVC (-20.0% vs. -13.0%, p=0.006) than the non-PAL group at 6 months postoperatively.

Conclusion: Postoperative PAL delayed the recovery of pulmonary function after lobectomy. These effects were markedly more pronounced after lower lobectomy than after upper lobectomy.