Quality of life after tailored combined surgery for stage I non-small-cell lung cancer and severe emphysema.
BACKGROUND
We analyzed the early and long-term quality of life changes occurring in 16 patients undergoing tailored combined surgery for stage I non-small-cell lung cancer (NSCLC) and severe emphysema.


METHODS
Mean age was 65 +/- 5 years. All patients had severe emphysema with severely impaired respiratory function and quality of life. Tumor resection was performed with sole lung volume reduction (LVR) in 5 patients, separate wedge resection in 3 patients, segmentectomy in 2 patients, and lobectomy in 6 patients. A bilateral LVR was performed in 5 patients. Quality of life was assessed at baseline and every 6 months postoperatively by the Short-form 36 (SF-36) item questionnaire.


RESULTS
Mean follow-up was 44 +/- 21 months. All tumors were pathologic stage I. There was no hospital mortality nor major morbidity. Significant improvements occurred for up to 36 months in the general health (p = 0.02) domain and for up to 24 months in physical functioning (p = 0.02), role physical (p = 0.005), and general health (p = 0.01) SF-36 domains. Associated improvements regarded dyspnea index (-1.3 +/- 0.6) forced expiratory volume in one second (+0.28 +/- 0.2L), residual volume (-1.18 +/- 0.5L) and 6-minute-walking test distance (+86 +/- 67 m). Actuarial 5-year survival was similar to that of patients with no cancer undergoing LVRS during the same period (68% vs 82%, p = not significant).


CONCLUSIONS
Our study suggests that selected patients with stage I NSCLC and severe emphysema may significantly benefit from tailored combined surgery in terms of long-term quality of life and survival.
Pompeo
Eugenio
E
Division of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy. pompeo@med.uniroma2.it
De Dominicis
Enrico
E
Ambrogi
Vincenzo
V
Mineo
Davide
D
Elia
Stefano
S
Mineo
Tommaso C
TC
D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D010146:Pain; D011013:Pneumonectomy; D011183:Postoperative Complications; D011656:Pulmonary Emphysema / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D011788:Quality of Life; D015656:Respiratory Mechanics; D011795:Surveys and Questionnaires; D015996:Survival Rate