Postoperative pulmonary compensation after lung cancer surgery: a shift towards a modern and comprehensive model—a narrative review

Background and Objective: Pulmonary lobectomies result in permanent tissue loss and postoperative compensatory adaptations of the remaining lung volume. The structural remodelling processes of the tracheobronchial tree significantly influence postoperative functional tests and predispose to complex scenarios such as redistribution of the pulmonary airflow rate and steno-obstructive phenomena affecting patients’ quality of life. Moreover, in the context of a second primary lung neoplasm, the reduced adult pulmonary parenchymal plasticity and residual exercise intolerance due to postoperative changes rises anaesthesiologic challenges in case of need for surgical re-intervention. The aim of this unsystematic narrative review is to highlight correlations between morpho-dynamic changes of the tracheobronchial tree and postoperative steno-obstructive symptoms in patients undergoing lung surgery. Methods: An unsystematic narrative review of published article about post-operative pulmonary compensation after lobectomies for non-small cell lung cancer (NSCLC) by querying PubMed and Scopus databases was conducted. According to the Medical Subject Heading (MeSH) items, search terms were: pulmonary compensation or remodel; lung cancer; surgery; post-operative pulmonary function; anatomic changes; lung mechanics; ventilation; one-lung ventilation; post-operative pulmonary tests. Inclusion criteria were: papers written in English about post-resectional anatomic and dynamic pulmonary compensation [2010–2023]. Key Content and Findings: This review will focus on pathophysiological and clinical challenges about of postoperative pulmonary compensations in NSCLC patients undergoing lobectomy. Conclusions: Postoperative pulmonary adaptive response involves morpho-structural and dynamic compensations of air-flow redistribution resource in response to surgical stress as the epiphenomenon of a complex cooperation between the host response, recruitment of alveolar-capillary reserves and fluid dynamics influencing postoperative respiratory function and medium-long term sequelae in surgical NSCLC patients.