Evaluation of high-risk lung resection candidates: pulmonary haemodynamics versus exercise testing. A series of five patients.
We compared the value of exercise testing and measurement of pulmonary haemodynamics (PH) in the pre-operative assessment of 5 patients (mean age: 64 years, 3 men) with clinical stage I or II bronchogenic carcinoma and severe chronic obstructive pulmonary disease. They were considered at high risk due to poor pulmonary function tests (PFT); (one or more of the following): (1) radionuclide calculated postlobectomy FEV1 < 30% predicted, (2) diffusion capacity or transfer factor < 60% predicted, combined with a fall in PaO2 on maximal exercise of > 5 mm Hg, (3) a PaCO2 at rest of > 45 mm Hg. Maximal oxygen uptake (VO2max) during symptom-limited cycle ergometry and PH were measured in these 5 patients. They were considered eligible for lobectomy if they fulfilled at least one of the two criteria: (1) mean pulmonary artery pressure (PAP) of < 35 mm Hg and pulmonary vascular resistance of < 190 dyn.s.cm-5 at moderate exercise (40 W), (2) a VO2max of > or = 15 ml/kg/min. Six months postoperatively PFT and VO2max were measured again. PAP40W was 21, 38, 38, 46 and 52 mm Hg, respectively, which would have excluded 4/5 patients from surgery. VO2max was 21.7, 14.9, 13.4, 19.2 and 18.6 ml/kg/min, respectively, which would have excluded 2/5 patients. Expressed in percent predicted, however, VO2max was > or = 69% in all 5 patients, indicating only mild impairment of exercise capacity in the 2 patients with < 15 ml/kg/min VO2max. Therefore all 5 patients were offered surgery and underwent lobectomy. Apart from 1 prolonged air leak no complications occurred, the mean hospital stay was 16 days (13-21).(ABSTRACT TRUNCATED AT 250 WORDS)
Bolliger
C T
CT
Department of Internal Medicine, University Hospital, Basel, Switzerland.
Solèr
M
M
Stulz
P
P
Grädel
E
E
Müller-Brand
J
J
Elsasser
S
S
Gonon
M
M
Wyser
C
C
Perruchoud
A P
AP
D000368:Aged; D002245:Carbon Dioxide / Q000097:blood; D002283:Carcinoma, Bronchogenic / Q000503:physiopathology / Q000601:surgery*; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume / Q000502:physiology; D006439:Hemodynamics; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008173:Lung Diseases, Obstructive / Q000503:physiopathology / Q000601:surgery*; D008175:Lung Neoplasms / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010101:Oxygen Consumption / Q000502:physiology; D011013:Pneumonectomy; D011653:Pulmonary Diffusing Capacity / Q000502:physiology; D012129:Respiratory Function Tests; D012307:Risk Factors; D014109:Total Lung Capacity / Q000502:physiology
D002245:Carbon Dioxide; D010100:Oxygen