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Fiorelli A, Leonardi B, Messina G, Luzzi L, Paladini P, Catelli C, Minervini F, Kestenholz P, Teodonio L, D’Andrilli A, Rendina EA, Natale G. Lung Resection for Non-Small Cell Lung Cancer following Bronchoscopic Lung Volume Reduction for Heterogenous Emphysema. Cancers (Basel) 2024; 16:605. [PMID: 38339355 PMCID: PMC10854739 DOI: 10.3390/cancers16030605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
Bronchoscopic lung volume reduction (BLVR) is a minimally invasive treatment for emphysema. Lung cancer may be associated with emphysema due to common risk factors. Thus, a growing number of patients undergoing BLVR may develop lung cancer. Herein, we evaluated the effects of lung resection for non-small cell lung cancer in patients undergoing BLVR. The clinical data of patients undergoing BLVR followed by lung resection for NSCLC were retrospectively reviewed. For each patient, surgical and oncological outcomes were recorded to define the effects of this strategy. Eight patients were included in our series. In all cases but one, emphysema was localized within upper lobes; the tumor was detected during routine follow-up following BLVR and it did not involve the treated lobe. The comparison of pre- and post-BLVR data showed a significant improvement in FEV1 (29.7 ± 4.9 vs. 33.7 ± 6.7, p = 0.01); in FVC (28.5 ± 6.6 vs. 32.4 ± 6.1, p = 0.01); in DLCO (31.5 ± 4.9 vs. 38.7 ± 5.7, p = 0.02); in 6MWT (237 ± 14 m vs. 271 ± 15 m, p = 0.01); and a reduction in RV (198 ± 11 vs. 143 ± 9.8, p = 0.01). Surgical resection of lung cancer included wedge resection (n = 6); lobectomy (n = 1); and segmentectomy (n = 1). No major complications were observed and the comparison of pre- and post-operative data showed no significant reduction in FEV1% (33.7 ± 6.7 vs. 31.5 ± 5.3; p = 0.15) and in DLCO (38.7 ± 5.7 vs. 36.1 ± 5.4; p = 0.15). Median survival was 35 months and no cancer relapses were observed. The improved lung function obtained with BLVR allowed nonsurgical candidates to undergo lung resection for lung cancer.
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Affiliation(s)
- Alfonso Fiorelli
- Division of Thoracic Surgery, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (B.L.); (G.M.); (G.N.)
| | - Beatrice Leonardi
- Division of Thoracic Surgery, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (B.L.); (G.M.); (G.N.)
| | - Gaetana Messina
- Division of Thoracic Surgery, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (B.L.); (G.M.); (G.N.)
| | - Luca Luzzi
- Lung Transplantation Unit, University of Siena, 53100 Siena, Italy; (L.L.); (P.P.); (C.C.)
| | - Piero Paladini
- Lung Transplantation Unit, University of Siena, 53100 Siena, Italy; (L.L.); (P.P.); (C.C.)
| | - Chiara Catelli
- Lung Transplantation Unit, University of Siena, 53100 Siena, Italy; (L.L.); (P.P.); (C.C.)
| | - Fabrizio Minervini
- Division of Thoracic Surgery, Cantonal Hospital Lucerne, 6000 Lucerne, Switzerland; (F.M.); (P.K.)
| | - Peter Kestenholz
- Division of Thoracic Surgery, Cantonal Hospital Lucerne, 6000 Lucerne, Switzerland; (F.M.); (P.K.)
| | - Leonardo Teodonio
- Division of Thoracic Surgery, Sapienza University, Sant’Andrea Hospital, 00189 Rome, Italy; (L.T.); (A.D.); (E.A.R.)
| | - Antonio D’Andrilli
- Division of Thoracic Surgery, Sapienza University, Sant’Andrea Hospital, 00189 Rome, Italy; (L.T.); (A.D.); (E.A.R.)
| | - Erino Angelo Rendina
- Division of Thoracic Surgery, Sapienza University, Sant’Andrea Hospital, 00189 Rome, Italy; (L.T.); (A.D.); (E.A.R.)
| | - Giovanni Natale
- Division of Thoracic Surgery, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (B.L.); (G.M.); (G.N.)
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Wei S, Chen F, Liu R, Fu D, Wang Y, Zhang B, Ren D, Ren F, Song Z, Chen J, Xu S. Outcomes of lobectomy on pulmonary function for early stage non-small cell lung cancer (NSCLC) patients with chronic obstructive pulmonary disease (COPD). Thorac Cancer 2020; 11:1784-1789. [PMID: 32374491 PMCID: PMC7592038 DOI: 10.1111/1759-7714.13445] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/02/2020] [Accepted: 04/04/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Lung cancer is the first cause of cancer mortality worldwide. Chronic obstructive pulmonary disease (COPD) is an independent risk factor for lung cancer. An epidemiological survey discovered that the presence of COPD increases the risk of lung cancer by 4.5-fold. Lobectomy is considered to be the standard surgical method for early stage non-small cell lung cancer (NSCLC). However, the influence of lobectomy on the loss of pulmonary function has not been fully investigated in NSCLC patients with COPD. METHODS We searched the PubMed database using the following strategies: COPD and pulmonary function test (MeSH term) and lobectomy (MeSH term) from 01 January 1990 to 01 January 2019. We selected the articles of patients with COPD. A total of six studies, including 195 patients with COPD, provided lung function values before and after surgery. RESULTS Five out of six studies focused on the short-term change of pulmonary function (within 3-6 months) after lobectomy, and the average loss of FEV1 was 0.11 L (range: -0.33-0.09 L). One study investigated the long-term change of pulmonary function (within 1-2 years) after lobectomy, and the average loss of FEV1 was 0.15 L (range: -0.29-0.05 L). CONCLUSIONS A short-term (3-6 months) loss of pulmonary function after operation is acceptable for lung cancer patients with COPD. However, there may be a high risk of postoperative complications in NSCLC patients with COPD. Therefore, surgical treatment needs to be carefully considered for these patients.
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Affiliation(s)
- Sen Wei
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Feng Chen
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Renwang Liu
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Dianxun Fu
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yanye Wang
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Bo Zhang
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Dian Ren
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Fan Ren
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Zuoqing Song
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Jun Chen
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Song Xu
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
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Newsome BR, McDonnell K, Hucks J, Dawson Estrada R. Chronic Obstructive Pulmonary Disease: Clinical Implications for Patients With Lung Cancer. Clin J Oncol Nurs 2019; 22:184-192. [PMID: 29547609 DOI: 10.1188/18.cjon.184-192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is the most common smoking-related illness. COPD often is underemphasized as a comorbidity except when considering issues surrounding surgical treatment options. OBJECTIVES This article aims to provide nurses with an overview of the pharmacologic and nonpharmacologic treatment implications of COPD. METHODS Definitions, differentials, and treatment considerations are provided, and clinical implications and resources are described. FINDINGS The added burden of dyspnea, fatigue, and psychological distress related to COPD may affect the overall outcome and quality of life (QOL) of patients with lung cancer. Attention to the prevention, assessment, and treatment of lung cancer and COPD and related symptomatology will help maximize patients' QOL.
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Caviezel C, von Rotz J, Schneiter D, Inci I, Hillinger S, Opitz I, Weder W. Improved postoperative lung function after sublobar resection of non-small-cell lung cancer combined with lung volume reduction surgery in patients with advanced emphysema. J Thorac Dis 2018; 10:S2704-S2710. [PMID: 30210822 DOI: 10.21037/jtd.2018.06.79] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Radiotherapy is recommended as primary local therapy for inoperable patients with non-small cell lung cancer (NSCLC). We hypothesized that selected patients with advanced emphysema could be candidates for surgery and improved functional outcome might result in addition to low mortality and morbidity and successful cancer control when sublobar resection in a lung volume reduction surgery (LVRS) concept is applied. Methods All patients with NSCLC and severe emphysema who underwent cancer resection in a LVRS concept between 2003 and 2015 were included for analysis. Postoperative 90-day mortality, complications, survival and lung function with forced expiratory volume in one second pre-operatively and three months postoperatively served as endpoints. Results Fourteen patients were included. Three procedures were bilateral and eleven unilateral, eight have been performed with thoracoscopy and six with conversion to an open procedure due to adhesions. In ten patients, tumor resection was atypical and in four patients an anatomic segmentectomy was performed. All patients had lung volume reduction. Prolonged air leak occurred in three patients. Perioperative 90-mortality was zero. Median pre-operative forced expiratory volume in one second was 32.5% and increased to 37% (P=0.002) 3 months following surgery. Three and 5-year survival rates were 50% and 35%, respectively. Conclusions Sublobar resection of NSCLC combined with LVRS in patients with severely impaired lung function due to emphysema can be performed with low mortality and morbidity making it an alternative treatment modality to radiotherapy. This approach allows cancer resection in marginal patients and improves emphysema symptoms simultaneously.
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Affiliation(s)
- Claudio Caviezel
- Department of Thoracic Surgery, University Hospital Zurich, Switzerland
| | - Julia von Rotz
- Department of Thoracic Surgery, University Hospital Zurich, Switzerland
| | - Didier Schneiter
- Department of Thoracic Surgery, University Hospital Zurich, Switzerland
| | - Ilhan Inci
- Department of Thoracic Surgery, University Hospital Zurich, Switzerland
| | - Sven Hillinger
- Department of Thoracic Surgery, University Hospital Zurich, Switzerland
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Switzerland
| | - Walter Weder
- Department of Thoracic Surgery, University Hospital Zurich, Switzerland
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Binkley MS, King MT, Shrager JB, Bush K, Chaudhuri AA, Popat R, Gensheimer MF, Maxim PG, Henry Guo H, Diehn M, Nair VS, Loo BW. Pulmonary function after lung tumor stereotactic ablative radiotherapy depends on regional ventilation within irradiated lung. Radiother Oncol 2017; 123:270-275. [PMID: 28460826 DOI: 10.1016/j.radonc.2017.03.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 03/07/2017] [Accepted: 03/20/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE To determine if regional ventilation within irradiated lung volume predicts change in pulmonary function test (PFT) measurements after stereotactic ablative radiotherapy (SABR) of lung tumors. METHODS We retrospectively identified 27 patients treated from 2007 to 2014 at our institution who received: (1) SABR without prior thoracic radiation; (2) pre-treatment 4-dimensional computed tomography (4-D CT) imaging; (3) pre- and post-SABR PFTs <15months from treatment. We defined the ventilation ratio (VR20BED3) as the quotient of mean ventilation (mean Jacobian-based per-voxel volume change on deformably registered inhale/exhale 4-D CT phases) within the 20Gy biologically effective dose (α/β=3Gy) isodose volume and that of the total lung volume (TLV). RESULTS Most patients had moderate to very severe COPD by GOLD criteria (n=19, 70.1%). Higher VR20BED3 significantly predicted worse change in Forced Expiratory Volume/s normalized by baseline value (ΔFEV1/FEV1pre, p=0.04); n=7 had VR20BED3>1 (high regional ventilation) and worse ΔFEV1/FEV1pre (median=-0.16, range=-0.230 to -0.20). Five had VR20BED3<1 (low regional ventilation) and improved ΔFEV1/FEV1pre (median=0.13, range=0.07 to 0.20). In a multivariable linear model, increasing VR20BED3 and time to post-SABR PFT predicted decreasing ΔFEV1/FEV1pre (R2=0.25, p=0.03). CONCLUSIONS After SABR to high versus low functioning lung regions, we found worsened or improved global pulmonary function, respectively. If pre-SABR VR20BED3 is validated as a predictor of eventual post-SABR PFT in larger studies, it may be used for individualized treatment planning to preserve or even improve pulmonary function after SABR.
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Affiliation(s)
- Michael S Binkley
- Department of Radiation Oncology and Cancer Institute, Stanford University School of Medicine, United States
| | - Martin T King
- Department of Radiation Oncology and Cancer Institute, Stanford University School of Medicine, United States
| | - Joseph B Shrager
- Department of Cardiothoracic Surgery, Division of Thoracic Surgery, Stanford University School of Medicine, United States; Stanford Cancer Institute and Department of Medicine, United States
| | - Karl Bush
- Department of Radiation Oncology and Cancer Institute, Stanford University School of Medicine, United States
| | - Aadel A Chaudhuri
- Department of Radiation Oncology and Cancer Institute, Stanford University School of Medicine, United States
| | - Rita Popat
- Department of Health Research & Policy, Stanford University School of Medicine, United States
| | - Michael F Gensheimer
- Department of Radiation Oncology and Cancer Institute, Stanford University School of Medicine, United States
| | - Peter G Maxim
- Department of Radiation Oncology and Cancer Institute, Stanford University School of Medicine, United States; Stanford Cancer Institute and Department of Medicine, United States
| | - H Henry Guo
- Department of Radiology, Stanford University School of Medicine, United States
| | - Maximilian Diehn
- Department of Radiation Oncology and Cancer Institute, Stanford University School of Medicine, United States; Institute for Stem Cell Biology & Regenerative Medicine, Stanford University School of Medicine, United States; Stanford Cancer Institute and Department of Medicine, United States
| | - Viswam S Nair
- Department of Radiology, Stanford University School of Medicine, United States; Department of Medicine, Division of Pulmonary and Critical Care Medicine, Stanford Cancer Institute and Department of Medicine, United States; Stanford Cancer Institute and Department of Medicine, United States.
| | - Billy W Loo
- Department of Radiation Oncology and Cancer Institute, Stanford University School of Medicine, United States; Stanford Cancer Institute and Department of Medicine, United States.
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Abstract
Locally advanced lung cancer remains a surgical indication in selected patients. This condition often demands larger resections. As a consequence preoperative functional workup is of paramount importance to stratify the risk and choose the most appropriate treatment. We reviewed the current evidence on functional evaluation with a special focus on specific aspects related to locally advanced lung cancer stages (i.e., risk after neoadjuvant treatment, pneumonectomy). Evidence is discussed to provide information that could assist clinicians in their preoperative workup of these challenging patients.
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Abstract
PURPOSE OF REVIEW Surgery is considered the best treatment option for patients with early stage lung cancer. Nevertheless, lung resection may cause a variable functional impairment that could influence the whole cardio-respiratory system with potential life-threatening complications. The aim of the present study is to review the most relevant evidences about the evaluation of surgical risk before lung resection, in order to define a practical approach for the preoperative functional assessment in lung cancer patients. RECENT FINDINGS The first step in the preoperative functional evaluation of a lung resection candidate is a cardiac risk assessment. The predicted postoperative values of forced expiratory volume in one second and carbon monoxide lung diffusion capacity should be estimated next. If both values are greater than 60 % of the predicted values, the patients are regarded to be at low surgical risk. If either or both of them result in values lower than 60 %, then a cardiopulmonary exercise test is recommended. Patients with VO2max >20 mL/kg/min are regarded to be at low risk, while those with VO2max <10 mL/kg/min at high risk. Values of VO2max between 10 and 20 mL/kg/min require further risk stratification by the VE/VCO2 slope. A VE/VCO2 <35 indicates an intermediate-low risk, while values above 35 an intermediate-high risk. SUMMARY The recent scientific evidence confirms that the cardiologic evaluation, the pulmonary function test with DLCO measurement, and the cardiopulmonary exercise test are the cornerstones of the preoperative functional evaluation before lung resection. We present a simplified functional algorithm for the surgical risk stratification in lung resection candidates.
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Affiliation(s)
- Michele Salati
- Division of Thoracic Surgery, Ospedali Riuniti Ancona, Via Conca 1, 60020 Ancona, Italy
| | - Alessandro Brunelli
- Department Thoracic Surgery, St. James’s University Hospital, Beckett Street, Leeds, LS9 7TF UK
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Ansari BM, Hogan MP, Collier TJ, Baddeley RA, Scarci M, Coonar AS, Bottrill FE, Martinez GC, Klein AA. A Randomized Controlled Trial of High-Flow Nasal Oxygen (Optiflow) as Part of an Enhanced Recovery Program After Lung Resection Surgery. Ann Thorac Surg 2016; 101:459-64. [DOI: 10.1016/j.athoracsur.2015.07.025] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 05/08/2015] [Accepted: 07/13/2015] [Indexed: 10/23/2022]
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Makey I, Berger RL, Cabral HJ, Celli B, Folch E, Whyte RI. Maximal Oxygen Uptake--Risk Predictor of NSCLC Resection in Patients With Comorbid Emphysema: Lessons From NETT. Semin Thorac Cardiovasc Surg 2015; 27:225-31. [PMID: 26686452 DOI: 10.1053/j.semtcvs.2015.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2015] [Indexed: 12/25/2022]
Abstract
We compared VO2 max values from ACCP Guidelines and from NETT's homogenous NULPD surrogate for predicting operative mortalities. Estimated mid and long-term non-cancer related survival in NETT's subset was also obtained. NETT and ACCP Guideline VO2 max values were similar in the "low" and "mid" risk operative mortality categories but NETT's "high" risk subset showed lower mortality (14% vs. 26%). Estimated non-cancer related survival in NETT "low", "mid" and "high" risk VO2 max categories at two and eight years were 100%, 74%, 59% and 48%, 26%, 14%, respectively. The lower predicted risk in NETT's "high- risk" subset raises the possibility of extending indications for potential curative resection in selected patients. The NETT surrogate also provides hitherto unavailable estimate on long-term non-cancer related survival after potential curative resection of NSCLC and suggests that the operation does not shorten eight-year longevity.
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Affiliation(s)
- Ian Makey
- Division of Cardiothoracic Surgery, University of Texas San Antonio Health Sciences Center, San Antonio, Texas
| | - Robert L Berger
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
| | - Howard J Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Bartolome Celli
- Department of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Erik Folch
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Richard I Whyte
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Drakou E, Kanakis MA, Papadimitriou L, Iacovidou N, Vrachnis N, Nicolouzos S, Loukas C, Lioulias A. Changes in Simple Spirometric Parameters After Lobectomy for Bronchial Carcinoma. J Cardiovasc Thorac Res 2015; 7:68-71. [PMID: 26191395 PMCID: PMC4492181 DOI: 10.15171/jcvtr.2015.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Accepted: 05/25/2015] [Indexed: 11/19/2022] Open
Abstract
Introduction: The purpose of this study was to describe the postoperative changes in lung function after pure open lobectomy for lung carcinoma.
Methods: 30 patients (mean age 64 ± 7 years old, 16 men and 14 women) underwent a left or right lobectomy. They underwent spirometric pulmonary tests preoperatively, and at 1 and 6 months after the operation.
Results: The average preoperative forced expiratory volume in 1 second (FEV1) was 2.55±0.62lt and the mean postoperative FEV1 at 1 and 6 months was 1.97 ± 0.59 L and 2.15±0.66 L respectively. The percentage losses for FEV1 were 22.7% and 15.4% after 1 and 6 months respectively. An average percentage increase of 9.4% for FEV1 was estimated at the time of 6 months in comparison with this of 1 month after the operation. The average preoperative forced vital capacity (FVC) was 3.17 ± 0.81 L and the mean postoperative FVC at 1 and 6 months after the operation was 2.50 ± 0.63 L and 2.72 ± 0.67 L respectively. The percentage losses for FVC were 21.1% and 14.2% after 1 and 6 months respectively. An average percentage increase of 8.7% was observed at the time period of 6 months in comparison with this of 1 month after the operation.
Conclusion: Although, we observed a significant decrease in FEV1 and FVC after the operation, all patients were in excellent clinical status. FEV1 and FVC of 6 months were increased in comparison with the respective values of 1 month after the operation, but did not reach the preoperative values in any patient.
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Affiliation(s)
- Eleni Drakou
- Department of Thoracic Surgery, Sismanoglio General Hospital of Athens, Athens, Greece
| | - Meletios A Kanakis
- Department of Thoracic Surgery, Sismanoglio General Hospital of Athens, Athens, Greece
| | | | - Nicoletta Iacovidou
- Department of Neonatology, Aretaieio Hospital, School of Medicine, University of Athens, Athens, Greece
| | - Nikolaos Vrachnis
- 2nd Department of Obstetrics and Gynecology, Aretaieio Hospital, School of Medicine, University of Athens, Athens, Greece
| | - Stefanos Nicolouzos
- Department of Thoracic Surgery, Sismanoglio General Hospital of Athens, Athens, Greece
| | - Constantinos Loukas
- Medical Physics Laboratory, School of Medicine, University of Athens, Athens, Greece
| | - Achilleas Lioulias
- Department of Thoracic Surgery, Sismanoglio General Hospital of Athens, Athens, Greece
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Brunelli A, Kim AW, Berger KI, Addrizzo-Harris DJ. Physiologic Evaluation of the Patient With Lung Cancer Being Considered for Resectional Surgery. Chest 2013; 143:e166S-e190S. [DOI: 10.1378/chest.12-2395] [Citation(s) in RCA: 542] [Impact Index Per Article: 49.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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12
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Ghoneimy YE, Regal M, El-Tahan M, Deria A, Jehani YA, Matthani M. Changes in cerebral oxygenation in patients with pulmonary dysfunction after lung resection. Semin Cardiothorac Vasc Anesth 2012; 17:72-81. [PMID: 23108413 DOI: 10.1177/1089253212463968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Lung resection would be associated with lower jugular bulb oxygen saturation (SjvO₂) values in patients with moderate to severe pulmonary dysfunction. We aimed to study the effects of lung resections on the postoperative changes in SjvO₂, incidence of SjvO₂ < 50%, pulmonary functions, cerebral blood flow equivalent (CBFE), and arterial to jugular difference in oxygen content (AjvDO₂) in the patients with pulmonary dysfunction. Fifty-three patients scheduled for lung resection were allocated on the basis of forced vital capacity (FVC %) and forced expiratory volume in 1 second (FEV(1)%) into the following: good FVC and FEV₁ (n = 14), mild (n = 14), moderate (n = 13), and severe (n = 12) pulmonary dysfunction groups. After lung resections, patients with pulmonary dysfunctions had significantly lower SjvO₂, CBFE, FEV₁, and FVC (P < .001), higher AjvDO₂ (P < .001), and frequent episodes with SjvO₂ < 50% (P < .03). Perioperative changes in FEV₁ had a significant negative correlation with SjvO₂ desaturation (P < .002). Patients with pulmonary dysfunction showed significant SjvO₂ < 50% after lung resection, which is correlated to the perioperative changes in FEV₁.
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Ueda K, Tanaka T, Hayashi M, Li TS, Kaneoka T, Tanaka N, Hamano K. Compensation of pulmonary function after upper lobectomy versus lower lobectomy. J Thorac Cardiovasc Surg 2011; 142:762-7. [DOI: 10.1016/j.jtcvs.2011.04.037] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Revised: 03/15/2011] [Accepted: 04/19/2011] [Indexed: 10/18/2022]
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Yacoub WN, Meyers BF. Surgical resection in combination with lung volume reduction surgery for stage I non-small cell lung cancer. Semin Thorac Cardiovasc Surg 2011; 22:38-43. [PMID: 20813315 DOI: 10.1053/j.semtcvs.2010.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2010] [Indexed: 11/11/2022]
Abstract
Surgical resection remains the favored option of treatment for stage I lung cancer patients. Co-existing obstructive lung disease can reduce lung function and increase the risk of surgery. Severe emphysema may preclude resection of lung cancer due to concerns about low values of postoperative lung function. However, many patients will experience stable or improved lung function simply by resecting hyper-expanded and relatively functionless lung. This so-called "lung volume reduction effect" may occur after standard resection or after rare instances of formal lung volume reduction surgery concurrent with pulmonary resection of the tumor. This review explores these possibilities and informs the readers of pioneering work in this area.
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Affiliation(s)
- Wael N Yacoub
- Division of Cardiothoracic Surgery, Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, Missouri, USA
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Michelet P, Blayac D, Vincent A, D'Journo XB, Perrin G, Badier M, Thomas P, Brégeon F. How do COPD and healthy-lung patients tolerate the reduced volume ventilation strategy during OLV ventilation. Acta Anaesthesiol Scand 2010; 54:1128-36. [PMID: 20887415 DOI: 10.1111/j.1399-6576.2010.02281.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although a strategy of tidal volume (V(t)) reduction during the one-lung ventilation (OLV) period is advised in thoracic surgery, the influence of the pre-operative respiratory status on the tolerance of this strategy remains unknown. Therefore, the aim of this study was to compare the pulmonary function between chronic obstructive pulmonary disease (COPD) and healthy-lung patients during the operative and the post-operative period. METHODS Forty-eight patients undergoing a planned lobectomy for cancer and presenting either a healthy lung function (n=24) or a moderate COPD stage (n=24) were ventilated without external positive end-expiratory pressure (PEEP) and received 9 ml/kg V(t) during the two-lung ventilation (TLV) period, secondary reduced to 6 ml/kg during the OLV period. Lung function was assessed by peroperative gas exchange, venous admixture, respiratory mechanical parameters and post-operative spirometric measurements. RESULTS Although the PaO(2) was superior in the healthy-lung group during the TLV, once the OLV was established, no difference was observed between the two groups. Moreover, the PaO(2)/FiO(2) was proportionally more impaired in the healthy-lung group compared with the COPD group (50 ± 13 vs. 72 ± 19% of the baseline values after exclusion and 32 ± 15 vs. 51 ± 25% after the thoracotomy, P<0.05 for each) as well as the venous admixture. In the post-operative period, a higher decrease was observed in the healthy-lung group for the forced vital capacity and the forced expiratory volume. CONCLUSIONS Reducing V(t) to 6 ml/kg without the adjunction of external PEEP during OLV is associated with better preservation of lung function in the case of moderate COPD than in the case of healthy-lung status.
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Affiliation(s)
- P Michelet
- Réanimation des Urgences, Pôle Réanimation Urgence SAMU Hyperbarie, Hôpital Sainte-Marguerite, Marseille Cedex 9, France.
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Carretta A, Ciriaco P, Melloni G, Ballarin A, Bandiera A, Sestini S, Giovanardi M, Zannini P. Correlation of computed tomography densitometry and pathological grading of emphysema with the variation of respiratory function after lobectomy for lung cancer. Interact Cardiovasc Thorac Surg 2010; 10:914-7; discussion 917-8. [PMID: 20308264 DOI: 10.1510/icvts.2009.223974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The presence of emphysema may lead to an underestimation of postoperative respiratory function after lobectomy when evaluated by standard functional assessment. The aim of the study was to assess the correlation between computed tomography (CT) densitometry, pathological grading of emphysema and variation of pulmonary function after lobectomy for lung cancer. Forty-one patients entered the study. Respiratory function was assessed preoperatively and after a mean period of 4.04 months following surgery. Postoperative function remained unchanged or increased after surgery in nine patients (Group A). In the remaining 32 patients (Group B) postoperative function was reduced after surgery. Preoperative forced expiratory volume in 1 s (FEV(1))% was 68.5+/-13.1% in Group A and 91.7+/-21.0% in Group B. CT densitometry of the lobe to be resected was -877.8+/-57.6 HU in Group A and -827.5+/-64.4 HU in Group B. Pathological grading of emphysema of the resected lobe (range 0-10) was 4.1+/-2.2 in Group A and 3.1+/-1.2 in Group B. A significant correlation was observed (Spearman rank correlation) between the variation of FEV(1) and preoperative FEV(1) (P=0.003; r=-0.455), CT quantitative assessment (P=0.036; r=-0.430) and pathological grading (P=0.008; r=0.673). Patients with a higher degree of emphysema had a lower reduction of respiratory function after lobectomy and CT densitometry and pathological grading of emphysema correlated with the variation in respiratory function.
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Affiliation(s)
- Angelo Carretta
- Department of Thoracic Surgery, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy.
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Brunelli A. Risk Assessment for Pulmonary Resection. Semin Thorac Cardiovasc Surg 2010; 22:2-13. [DOI: 10.1053/j.semtcvs.2010.04.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2010] [Indexed: 12/20/2022]
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Kashiwabara K, Sasaki JI, Mori T, Nomori H, Fujii K, Kohrogi H. Relationship Between Functional Preservation after Segmentectomy and Volume-Reduction Effects after Lobectomy in Stage I Non-small Cell Lung Cancer Patients with Emphysema. J Thorac Oncol 2009; 4:1111-6. [DOI: 10.1097/jto.0b013e3181ae59e2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Choong CK, Mahesh B, Patterson GA, Cooper JD. Concomitant Lung Cancer Resection and Lung Volume Reduction Surgery. Thorac Surg Clin 2009; 19:209-16. [DOI: 10.1016/j.thorsurg.2009.04.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
Preoperative evaluation before lung resection has been frequently addressed in modern medical literature. Actual or predicted pulmonary volumes are considered relevant to predict the risk of surgery. Nevertheless, ppoFEV1 underestimates the real functional loss in the immediate postoperative period when most of the complications occur. Not all patients, however, have comparable functional changes after lobectomy. Minimal impairment or even improvements have been demonstrated in COPD cases after lobectomy. Efforts should be directed to an accurate prediction of the immediate postoperative pulmonary volumes for a better evaluation of high-risk patients caused by respiratory impairment. Future developments are needed on the role of measuring preoperative DLCO and how to evaluate a patient's general cardiorespiratory status. Evidence underlines the relevance of routine evaluation of preoperative DLCO at rest or, better, during exercise for a thorough assessment of patient's capability to adapt to a stressful situation (Fig. 3). Only by improving knowledge about the general condition of the patient, can one assess the physiologic response to surgery. Widespread use of sophisticated or simple exercise tests and measurements or daily activity using motion detectors can identify high-risk patients with otherwise acceptable pulmonary volumes. Another suggested investigation issue is to develop different relevant outcome parameters, not only from the surgeon's point of view but also from the patient's perspective, such as postoperative QOL-related variables or delayed outcomes. Finally, multidisciplinary investigation teams, including experts in mathematical modeling, are essential to improve the quality and validity of the developed models. Although knowledge about perioperative physiologic changes has increased, clinicians are still far from finding a way to put all this knowledge down and make it applicable for an individual patient. Multicentric cooperation and evaluation of large prospectively recorded databases are essential to develop evidence-based clinical guidelines on preoperative evaluation.
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Veeramachaneni NK, Meyers BF. Complications in patients with severe emphysema. Semin Thorac Cardiovasc Surg 2008; 19:343-9. [PMID: 18395636 DOI: 10.1053/j.semtcvs.2007.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2007] [Indexed: 11/11/2022]
Abstract
Thoracic surgeons frequently evaluate patients with severe emphysema and concomitant pathology requiring pulmonary resection. There are no absolute guidelines defining the suitability of a given patient for resection. In this review, we outline our approach to evaluating and treating patients with severe emphysema in need of resection. We describe the lessons learned from lung volume reduction surgery and apply that knowledge to the care of the patient with severe emphysema. Careful preoperative evaluation of the patient's lung anatomy, distribution of emphysematous changes in the lung, and overall health is essential to identifying the appropriate candidate for resection and avoiding postoperative complications.
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Affiliation(s)
- Nirmal K Veeramachaneni
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, MO 63110, USA
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Varela G, Brunelli A, Rocco G, Jiménez MF, Salati M, Gatani T. Evidence of Lower Alteration of Expiratory Volume in Patients With Airflow Limitation in the Immediate Period After Lobectomy. Ann Thorac Surg 2007; 84:417-22. [DOI: 10.1016/j.athoracsur.2007.03.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2006] [Revised: 02/14/2007] [Accepted: 03/05/2007] [Indexed: 10/23/2022]
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Brunelli A, Rocco G, Varela G. Predictive Ability of Preoperative Indices for Major Pulmonary Surgery. Thorac Surg Clin 2007; 17:329-36. [DOI: 10.1016/j.thorsurg.2007.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Brunelli A, Xiumé F, Refai M, Salati M, Marasco R, Sciarra V, Sabbatini A. Evaluation of Expiratory Volume, Diffusion Capacity, and Exercise Tolerance Following Major Lung Resection. Chest 2007; 131:141-7. [PMID: 17218568 DOI: 10.1378/chest.06-1345] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Lung resections determine a variable functional reduction depending on the extent of the resection and the time elapsed from the operation. The objectives of this study were to prospectively investigate the postoperative changes in FEV(1), carbon monoxide lung diffusion capacity (Dlco), and exercise tolerance after major lung resection at repeated evaluation times. METHODS FEV(1), Dlco, and peak oxygen consumption (Vo(2)peak) calculated using the stair climbing test were measured in 200 patients preoperatively, at discharge, and 1 month and 3 months after lobectomy or pneumonectomy. Preoperative and repeated postoperative measures were compared, and a time-series, cross-sectional regression analysis was performed to identify factors associated with postoperative Vo(2)peak. RESULTS One month after lobectomy, FEV(1), Dlco, and Vo(2)peak values were 79.5%, 81.5%, and 96% of preoperative values and recovered up to 84%, 88.5%, and 97% after 3 months, respectively. One month after pneumonectomy, FEV(1) percentage of predicted, Dlco percentage of predicted, and Vo(2)peak values were 65%, 75%, and 87% of preoperative values, and were 66%, 80%, and 89% after 3 months, respectively. Three months after lobectomy, 27% of patients with COPD had improved FEV(1), 34% had improved Dlco, and 43% had improved Vo(2)peak compared to preoperative values. The time-series, cross-sectional regression analysis showed that postoperative Vo(2)peak values were directly associated with preoperative values of Vo(2)peak, and postoperative values of FEV(1) and Dlco, and were inversely associated with age and body mass index. CONCLUSIONS Our findings may be used during preoperative counseling and for deciding eligibility for operation along with other more traditional measures of outcome.
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Baldi S, Ruffini E. Reply to the Editor. J Thorac Cardiovasc Surg 2006. [DOI: 10.1016/j.jtcvs.2006.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
Sublobar resection has been utilized as an alternative to lobectomy for the treatment of early-stage lung cancer in patients with compromised preoperative pulmonary function. Early data have suggested higher rates of local recurrence and increased late mortality for sublobar resection as compared with lobectomy. Subsequent studies have been mixed with respect to outcomes. Here we review the existing literature comparing sublobar resection to lobectomy with respect to oncologic and pulmonary outcomes. We also discuss the effect of adjuvant intraoperative brachytherapy to sublobar resection and summarize ongoing clinical trials that compare sublobar resection to sublobar resection plus adjuvant brachytherapy in the treatment of early-stage lung cancer. Finally, based on the current evidence, we provide recommendations as to when sublobar resection might be considered in the treatment of lung cancer.
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Affiliation(s)
- Ryan C Fields
- Division of Cardiothoracic Surgery, Barnes-Jewish Hospital, Washington University Medical Center, St. Louis, Missouri 63110-1013, USA
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Baldi S, Ruffini E, Harari S, Roviaro GC, Nosotti M, Bellaviti N, Venuta F, Diso D, Rea F, Schiraldi C, Durigato A, Pavanello M, Carretta A, Zannini P. Does lobectomy for lung cancer in patients with chronic obstructive pulmonary disease affect lung function? A multicenter national study. J Thorac Cardiovasc Surg 2005; 130:1616-22. [PMID: 16308007 DOI: 10.1016/j.jtcvs.2005.06.049] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2005] [Revised: 04/15/2005] [Accepted: 06/07/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the effect of lobectomy on pulmonary function in patients with chronic obstructive pulmonary disease. METHODS One hundred thirty-seven patients were analyzed; 49 had normal pulmonary function tests, and 88 had chronic obstructive pulmonary disease. Different functional parameter groups were identified: obstructive (forced expiratory volume in 1 second [FEV1], forced expiratory volume in 1 second/forced vital capacity [FEV1/FVC], and chronic obstructive pulmonary disease index), hyperinflation (residual volume and functional residual capacity), and diffusion (transfer factor of the lung for carbon monoxide). Also, the ratio between observed and predicted postoperative FEV(1) was calculated. RESULTS In patients with preoperative FEV1 greater than 80% of predicted, postoperative FEV1/FVC slightly but not significantly decreased, and postoperative FEV1 significantly decreased. In patients with preoperative FEV1 less than 65%, postoperative FEV1 and FEV1/FVC significantly increased. In patients with preoperative FEV1/FVC greater than 70%, postoperative FEV1 and FEV1/FVC significantly decreased. In patients with preoperative FEV1/FVC less than 70%, postoperative FEV1/FVC increased, and FEV1 remained unchanged. In patients with a chronic obstructive pulmonary disease index greater than 1.5, postoperative FEV1 and FEV1/FVC significantly decreased, whereas in patients with a chronic obstructive pulmonary disease index less than 1.5, postoperative FEV1/FVC significantly increased and FEV1 remained unchanged. In patients with residual volume and functional residual capacity greater than 115% and transfer factor of the lung for carbon monoxide less than 80% of predicted, postoperative FEV1 diminished less (not significant) compared with patients who had residual volume and functional residual capacity less than 115% (P = .0001). Observed postoperative/predicted postoperative FEV1 was higher if FEV1/FVC was less than 55% (1.46), if FEV1 was less than 80% of predicted (1.21), or if the chronic obstructive pulmonary disease index was less than 1.5 (1.17). CONCLUSIONS Patients with mild to severe chronic obstructive pulmonary disease could have a better late preservation of pulmonary function after lobectomy than healthy patients.
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Affiliation(s)
- Sergio Baldi
- Pulmonary Division, University Hospital S. Giovanni Battista of Torino, Torino, Italy.
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Choong CK, Meyers BF, Battafarano RJ, Guthrie TJ, Davis GE, Patterson GA, Cooper JD. Lung cancer resection combined with lung volume reduction in patients with severe emphysema. J Thorac Cardiovasc Surg 2004; 127:1323-31. [PMID: 15115989 DOI: 10.1016/j.jtcvs.2003.11.046] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Certain patients with resectable lung cancer and severe respiratory limitation due to emphysema may have a suitable operative risk by combining cancer resection with lung volume reduction surgery. The purpose of this study is to review our experience with such patients. METHODS A review was conducted on 21 patients with lung cancer in the setting of severe emphysema who underwent an operation designed to provide complete cancer resection and volume reduction effect. RESULTS In the 21 patients, the mean preoperative forced expiratory volume in 1 second was 0.7 +/- 0.2 L (29% predicted), residual volume was 5.5 +/- 1.0 L (271%), and diffusing capacity for carbon monoxide was 8.0 +/- 2.2 mL/min/mm Hg (34% predicted). In 9 patients, the cancer was located in a severely emphysematous lobe and the lung volume reduction surgery component of the procedure was accomplished with lobectomy alone. In the remaining 12 patients, the cancer resection lobectomy (n = 9) and wedge resection (n = 3) were supplemented with lung volume reduction surgery. Final pathologic staging was stage I in 16 patients, stage II in 2 patients, and stage III in 2 patients. One patient was found to have stage IV disease due to multifocal tumors in separate lobes. There were no hospital deaths. Postoperative complications included prolonged air leak in 11 patients, atrial fibrillation in 6 patients, and reintubation for ventilatory assistance in 2 patients. All patients showed improved lung function postoperatively. Survival was 100% and 62.7% at 1 and 5 years, respectively. CONCLUSIONS Patients with severe emphysema and resectable lung cancer who have a favorable anatomy for lung volume reduction surgery may undergo a combined cancer resection and lung volume reduction surgery with an acceptable risk and good long-term survival.
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Affiliation(s)
- Cliff K Choong
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, and Jacqueline Mariitz Lung Center at Barnes-Jewish Hospital, St Louis, MO 63110, USA
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Koizumi K, Haraguchi S, Hirata T, Hirai K, Mikami I, Fukushima M, Okada D, Yamagishi S, Nakajima Y, Tanaka S. Video-assisted lobectomy for a lung cancer patient with chronic obstructive pulmonary disease. Gen Thorac Cardiovasc Surg 2003; 51:569-76. [PMID: 14650585 DOI: 10.1007/bf02736695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This retrospective study was conducted to see whether a video-assisted lobectomy is beneficial in lung cancer patients with chronic obstructive pulmonary disease regarding preservation of pulmonary function compared to lobectomy by standard thoracotomy. SUBJECTS AND METHODS Between 1982 and 2002, 67 patients who underwent lobectomy for primary lung cancer showed 55% or less of preoperative forced expiratory volume in one second/vital capacity. Among them, 25 patients were enrolled in this retrospective study. The remaining 42 patients were excluded because of no presence of a postoperative pulmonary function test. Nine of 25 patients underwent a video-assisted lobectomy between 1994 and 2002 and the remaining 16 patients who underwent a lobectomy by standard thoracotomy between 1982 and 1994 were employed as a historical control. Perioperative conditions and changes in pulmonary function were compared between two groups. RESULTS A parameter of chest wall damage was minor in video-assisted lobectomy compared to that in lobectomy by standard thoracotomy. Changes between pre- and postoperative percent of vital capacity, forced expiratory volume in one second and maximal ventilatory volume showed significantly minor deterioration or even improvement in video-assisted lobectomy patients. Predicted postoperative pulmonary function tended to be underestimated for postoperative values in video-assisted lobectomy patients. CONCLUSIONS Video-assisted lobectomy seemed to be profitable in preservation of pulmonary function in lung cancer patients with chronic obstructive pulmonary disease. Prediction of postoperative pulmonary function should be revised due to the underestimation for postoperative values in video-assisted lobectomy, which could offer profitable surgical treatment for lung cancer patients with chronic obstructive pulmonary disease.
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Affiliation(s)
- Kiyoshi Koizumi
- Department of Surgery II, Nippon Medical School, Tokyo, Japan
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Sekine Y, Iwata T, Chiyo M, Yasufuku K, Motohashi S, Yoshida S, Suzuki M, Iizasa T, Saitoh Y, Fujisawa T. Minimal alteration of pulmonary function after lobectomy in lung cancer patients with chronic obstructive pulmonary disease. Ann Thorac Surg 2003; 76:356-61; discussion 362. [PMID: 12902063 DOI: 10.1016/s0003-4975(03)00489-2] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the influence of chronic obstructive pulmonary diseases (COPD) on postoperative pulmonary function and to elucidate the factors for decreasing the reduction of pulmonary function after lobectomy. METHODS We conducted a retrospective chart review of 521 patients who had undergone lobectomy for lung cancer at Chiba University Hospital between 1990 and 2000. Forty-eight patients were categorized as COPD, defined as percentage of predicted forced expiratory volume at 1 second (FEV1) less than or equal to 70% and percentage of FEV1 to forced vital capacity less than or equal to 70%. The remaining 473 patients were categorized as non-COPD. RESULTS Although all preoperative pulmonary function test data and arterial oxygen tension were significantly lower in the COPD group, postoperative arterial oxygen tension and FEV1 were equivalent between the two groups, and the ratio of actual postoperative to predicted postoperative FEV1 was significantly better in the COPD group (p < 0.001). With multivariable analysis, COPD and pulmonary resection of the lower portion of the lung (lower or middle-lower lobectomies) were identified as independent factors for the minimal deterioration of FEV1. Actual postoperative FEV1 was 15% lower and higher than predicted, respectively, in the non-COPD patients with upper portion lobectomy and the COPD patients with lower portion lobectomy. Finally, we created a new equation for predicting postoperative FEV1, and it produced a higher coefficient of determination (R(2)) than the conventional one. CONCLUSIONS The postoperative ventilatory function in patients with COPD who had lower or middle-lower lobectomies was better preserved than predicted.
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Affiliation(s)
- Yasuo Sekine
- Department of Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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Abstract
Lung cancer is one of the most common causes of death in elderly patients in the United States. Treatment advances have improved survival in selected patients. The available treatments carry the risk of morbidity and mortality but the benefit in most patients far outweighs the risks, given the dismal prognosis of untreated disease. Elderly patients with lung cancer need careful attention during pretreatment assessment. Advanced age alone, however, should not contraindicate aggressive treatment. In the high-risk groups it is important to involve a team of physicians including surgeons, radiation oncologists, medical oncologists, and pulmonologists, who are familiar with current treatment options and their risks.
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Affiliation(s)
- Jamie C Hey
- University of Maryland School of Medicine, 10 South Pine Street, Suite 800, Baltimore, MD 21201, USA.
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Waddell TK. Treatment of patients with lung cancer and severe emphysema: lessons from lung volume reduction surgery. Surg Oncol 2002; 11:201-6. [PMID: 12450556 DOI: 10.1016/s0960-7404(02)00045-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Lung volume reduction surgery (LVRS) is effective therapy for selected patients with end-stage emphysema. Surgery produces improved pulmonary function, increased exercise tolerance and enhanced quality of life. It has been shown to be superior to medical management over the short-term in randomized controlled trials. The experience gained by dealing with this select group of patients has had a substantial impact on management of lung cancer in some patients with advanced lung disease. Numerous surgical, anaesthetic, and nursing advances gained in dealing with lung volume reduction surgery (LVRS) procedures now allow surgery to be considered as the optimal cancer management technique. For some carefully selected candidates, cancer resection and LVRS can be performed simultaneously, with dual benefits. The physiologic principles underlying LVRS and selection guidelines will be reviewed. The impact on cancer management and the current strategy at Toronto General Hospital will also be presented.
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Affiliation(s)
- Thomas K Waddell
- Division of Thoracic Surgery, University of Toronto, Toronto General Hospital, Ont., Canada.
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Brunelli A, Al Refai M, Monteverde M, Sabbatini A, Xiumé F, Fianchini A. Predictors of early morbidity after major lung resection in patients with and without airflow limitation. Ann Thorac Surg 2002; 74:999-1003. [PMID: 12400735 DOI: 10.1016/s0003-4975(02)03852-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The aim of the present study was to identify predictors of morbidity after major lung resection for non-small cell lung carcinoma in patients with forced expiratory volume in 1 second (FEV1) greater than or equal to 70% of predicted and in those with FEV1 less than 70% of predicted. METHODS Five hundred forty-four patients who underwent lobectomy or pneumonectomy from 1993 through 2000 were retrospectively analyzed. The patients were divided into two groups: group A (450 cases), with FEV1 greater than or equal to 70%, and group B (94 cases), with FEV1 less than 70%. Differences between complicated and uncomplicated patients were tested within each group. RESULTS Morbidity rate was not significantly different between group A and group B (20.4% and 24.5%, respectively; p = 0.4). In group A, multivariate analysis showed that predicted postoperative FEV1 was the only significant independent predictor of complications. In group B, no significant predictor was identified. CONCLUSIONS In patients with preoperative FEV1 less than 70% of predicted, predicted postoperative FEV1 was not predictive of postoperative morbidity. Thus, predicted postoperative FEV1 should not be used alone as a selection criteria for operation in these high-risk patients.
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Edwards JG, Duthie DJ, Waller DA. Lobar volume reduction surgery: a method of increasing the lung cancer resection rate in patients with emphysema. Thorax 2001; 56:791-5. [PMID: 11562519 PMCID: PMC1745934 DOI: 10.1136/thorax.56.10.791] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Guidelines on patient selection for lung cancer resection identify a predicted postoperative forced expiratory volume in 1 second (ppoFEV(1)) of <40% as a predictor of high risk. Experience with lung volume reduction surgery suggests that ppoFEV(1) may be underestimated in those with concomitant emphysema. METHODS Anatomical lobectomy was performed in 29 patients with a resectable lung cancer within a poorly perfused, hyperinflated emphysematous lobe identified by radionuclide perfusion scintigraphy and computed tomographic scanning. Perioperative changes in spirometric parameters at 3 months were compared in 14 patients (group A) of mean age 69 years (range 48-78) with ppoFEV(1) <40% (mean (SD) 31.4 (7)%) and 15 patients (group B) with ppoFEV(1) >40% (mean (SD) 47 (5)%). The correlation between predicted and actual postoperative FEV(1) was also assessed. RESULTS In group B there was a significant perioperative reduction in FEV(1) (p=0.01) but in group A FEV(1) did not change significantly after lobectomy (p=0.87); mean difference in perioperative change between groups A and B 331 ml (95% CI 150 to 510). Despite the difference in ppoFEV(1) between the groups, there was no difference in actual FEV(1) at 3 months. In-hospital mortality was 14% in group A and zero in group B, but at a median follow up of 12 (range 6-40) months there was no difference in survival between the groups. CONCLUSIONS Selection for lung cancer resection in patients with emphysema using standard calculations of ppoFEV(1) may be misleading. The effect of lobar volume reduction allows for an extension of the selection criteria.
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Affiliation(s)
- J G Edwards
- Department of Thoracic Surgery, Glenfield Hospital, Leicester LE3 9QP, UK
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Culver BH. Preoperative assessment of the thoracic surgery patient: pulmonary function testing. Semin Thorac Cardiovasc Surg 2001; 13:92-104. [PMID: 11494200 DOI: 10.1053/stcs.2001.25041] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Tests of pulmonary function before thoracic surgery can help to assess the risk of perioperative morbidity and mortality, and are the basis for estimating remaining lung function after resection of lung tissue. Testing has evolved over the past 50 years from reliance on the maximum breathing capacity to a range of studies including spirometry, and measurement of lung volume, diffusing capacity, and arterial blood gases, and the interpretation of these in conjunction with radionuclide scanning. The surgeon must consider both the early postoperative decrement in function and the level to which the patient is expected to recover. Although it is difficult to establish absolute limiting values, and current surgical techniques are blurring the boundary further, the reported experience underlying current guidelines is reviewed.
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Affiliation(s)
- B H Culver
- Pulmonary and Critical Care Medicine, University of Washington Medical Center, Seattle, WA 98195, USA
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Leonard CT, Whyte RI, Lillington GA. Primary non-small-cell lung cancer: determining the suitability of the patient and tumor for resection. Curr Opin Pulm Med 2000; 6:391-5. [PMID: 10912651 DOI: 10.1097/00063198-200007000-00023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Choosing resective surgery for patients with bronchogenic carcinoma requires assessments of tumor suitability and patient suitability. Tumor suitability is largely dependent on the assessed stage of the tumor complex, based on characteristics of the primary tumor, detection of lymph node metastases, and detection of distant metastases. Imaging tests that assist in the determination of tumor stage include computed tomographic scans and positron emission tomographic (PET) scans. PET scans are more sensitive and specific than computed tomography. PET is also helpful in screening for distant metastases. Mediastinoscopy is required in most cases of mediastinal adenopathy. Patient suitability is assessed by predicting short-term surgical mortality, and the likelihood of crippling long-term respiratory failure. There is no single test that provides such information. Pulmonary function tests can be used to calculate the "predicted postoperative" function, and several algorithmic approaches have been devised to predict surgical risk. Assessments of regional pulmonary function are obtained with quantitative perfusion scintiscans. Cardiac function is also an important factor.
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Affiliation(s)
- C T Leonard
- Division of Pulmonary and Critical Care Medicine, Stanford University Medical Center, California, USA
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Abstract
Cardiac and thoracic surgery cause alterations in ventilatory function that can lead to significant postoperative pulmonary complications. These complications often occur among patients with pre-existing pulmonary dysfunction and cause significantly longer hospital stays. This review explores some of the recent literature concerning this issue, including the effects of lung reduction surgery.
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Affiliation(s)
- C Weissman
- Department of Anesthesiology and Critical Care Medicine, Hadassah-University Hospital, Jerusalem, Israel.
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