Long-Term Function Recovery Following Upper Versus Lower Lobectomy for Lung Cancer: A Multicenter Longitudinal Cohort Study

BACKGROUND: The effects of lobectomy at various lung sites on postoperative function and recovery vary. This study aimed at assessing the long-term impact of upper versus lower lobectomy on patients' postoperative daily function by analyzing patient-reported outcomes.

METHODS: This multicenter prospective cohort study enrolled patients from six hospitals in China. Functional impairments and symptom severity were measured using the MD Anderson Symptom Inventory-Lung Cancer. A mixed-effects linear model was employed to analyze the average trajectories of each functional item and the top five symptoms over the first year following surgery between patients undergoing upper and lower lobectomy. The median recovery days for daily function were estimated using the Kaplan-Meier method, with the log-rank test comparing differences between upper and lower lobectomy.

RESULTS: Two hundred twenty-six patients met the final analysis criteria, with 137 undergoing upper and 89 undergoing lower lobectomies. Those in the lower lobectomy group reported significantly greater interference with daily activities (estimate = 0.872, SE = 0.306, p = 0.004), mood (estimate = 0.667, SE = 0.297, p = 0.025), and work (estimate = 0.856, SE = 0.358, p = 0.017), indicating a more pronounced impact on postsurgical functional recovery compared to the upper lobectomy group within the first year after surgery. They also experienced longer median recovery times for daily activities (15 vs. 4 days), mood (6 vs. 3.5 days), and walking (7 vs. 4 days) compared to the upper lobectomy group.

CONCLUSIONS: Within the first year after surgery, lower lobectomy patients experienced greater impairment in daily functions and required longer recovery times compared to upper lobectomy patients.

TRIAL REGISTRATION: NCT03341377.