Improved ventilatory function after combined operation for pulmonary emphysema and lung cancer.
BACKGROUND
Smoking is the leading cause of both lung cancer and emphysema. Therefore, some patients with stage I and II disease will present with contra-indications to resection including a predicted postoperative FEV1 of less than 0.81 or a VO2max of less than 10 ml/kg/min. Recently, lung volume reduction surgery (LVRS) has re-emerged in the management of emphysema with excellent results.


METHODS
2 patients are reported with lung cancer in the left lower lobe and emphysematous destruction in both upper lobes. They, respectively, had a predicted postoperative FEV1 of 0.9211 and 0.6851. No metastases were present. Pre-operatively, a COPD index of 0.9 and 0.7 was calculated. A left lower lobectomy together with volume reduction of the left upper lobe was performed through a standard posterolateral thoracotomy.


RESULTS
Pathological examination showed, respectively, stage IIb and stage Ib disease. The postoperative course was uneventful and 3 months later a FEV1 of 1.441 for patient 1 and 1.041 for patient 2 were recorded.


CONCLUSIONS
These findings suggest that pulmonary function criteria for pulmonary resection have to be revised when patients can undergo simultaneous lung cancer resection and LVRS. The pre-operatively calculated COPD index can be used to predict which patients may not have a decrease in ventilatory function.
Sinjan
E A
EA
Department of Surgery, University Hospital of Antwerp, Belgium. erikonthemove@hotmail.com
Van Schil
P E
PE
Ortmanns
P
P
Van den Brande
F
F
Hendriks
J M
JM
Eyskens
E
E
D000368:Aged; D002283:Carcinoma, Bronchogenic / Q000150:complications / Q000601:surgery*; D005541:Forced Expiratory Volume; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000601:surgery*; D008297:Male; D011013:Pneumonectomy; D011656:Pulmonary Emphysema / Q000150:complications / Q000601:surgery*; D012123:Pulmonary Ventilation / Q000502:physiology