title: Lung reduction operation and resection of pulmonary nodules in patients with severe emphysema.
abstract: BACKGROUND
  Severe pulmonary dysfunction has been considered a relative contraindication to surgical resection in patients with solitary pulmonary nodules. We report our initial experience with the combined use of lung volume reduction operation and tumor resection in this patient population.
  
  
  METHODS
  Between January 1995 and July 1996, 14 patients underwent combined lung volume reduction operation and pulmonary nodule resection. Ten (71%) patients were oxygen dependent, 5 (36%) had a room air partial pressure of carbon dioxide > or = 45, and 5 (36%) were steroid dependent preoperatively. Mean preoperative pulmonary function tests included a forced expiratory volume in 1 second of 680 +/- 98 mL (24% +/- 5% predicted), forced vital capacity of 54% +/- 5% predicted, and a forced expiratory volume in 1 second to vital capacity ratio of 37% +/- 2% predicted.
  
  
  RESULTS
  Sixteen lesions were resected in the 14 patients and included 9 non-small cell carcinomas. There was one postoperative death. All other patients are alive and well through a mean follow-up of 22.6 +/- 2.3 months (12 to 35 months). At 6-month follow-up improvements were noted in dyspnea index, forced expiratory volume in 1 second forced vital capacity, and 6-minute walk distance. Mediastinal recurrence at 12-month follow-up developed in 1 patient with two separate bronchioalveolar carcinomas.
  
  
  CONCLUSIONS
  Simultaneous lung volume reduction operation and tumor resection should be considered in patients with emphysema with marginal reserve in the hope of maximizing postoperative lung function.
authors.affiliation: Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, Columbia-Presbyterian Medical Center, New York, New York 10032, USA.
authors.forename: J J
authors.initials: JJ
authors.lastname: DeRose
authors.forename: M
authors.initials: M
authors.lastname: Argenziano
authors.forename: N
authors.initials: N
authors.lastname: El-Amir
authors.forename: P A
authors.initials: PA
authors.lastname: Jellen
authors.forename: L A
authors.initials: LA
authors.lastname: Gorenstein
authors.forename: K M
authors.initials: KM
authors.lastname: Steinglass
authors.forename: B
authors.initials: B
authors.lastname: Thomashow
authors.forename: M E
authors.initials: ME
authors.lastname: Ginsburg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications / Q000503:physiopathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006801:Humans; D008168:Lung / Q000601:surgery*; D008175:Lung Neoplasms / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011656:Pulmonary Emphysema / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D003074:Solitary Pulmonary Nodule / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D014797:Vital Capacity