Evaluation of expiratory volume, diffusion capacity, and exercise tolerance following major lung resection: a prospective follow-up analysis.
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.
Brunelli
Alessandro
A
Division of Thoracic Surgery, "Umberto I" Regional Hospital, Ancona, Italy. alexit_2000@yahoo.com
Xiumé
Francesco
F
Refai
Majed
M
Salati
Michele
M
Marasco
Rita
R
Sciarra
Valeria
V
Sabbatini
Armando
A
D000368:Aged; D000704:Analysis of Variance; D002289:Carcinoma, Non-Small-Cell Lung / Q000503:physiopathology* / Q000601:surgery*; D005080:Exercise Test; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume / Q000502:physiology*; D006801:Humans; D008175:Lung Neoplasms / Q000503:physiopathology* / Q000601:surgery*; D008297:Male; D011013:Pneumonectomy; D011446:Prospective Studies; D011653:Pulmonary Diffusing Capacity / Q000502:physiology*; D012044:Regression Analysis; D016896:Treatment Outcome