[Impact of a rescue program on the operability of patients with bronchogenic carcinoma and chronic obstructive pulmonary disease].
OBJECTIVE
Bronchogenic carcinoma and chronic obstructive pulmonary disease (COPD) are strongly associated in our setting, occurring together in around 70% of cases. Approximately 60% of COPD patients who require resection for bronchogenic carcinoma are considered unfit for surgery because of seriously impaired lung function. The purpose of this study was to evaluate the extent to which a rescue program could improve lung function in COPD patients who had previously been considered unfit for surgery because of poor lung function.


METHODS
The study enrolled COPD patients who had not been considered for surgical resection because they had a predicted postoperative forced expiratory volume in 1 second (FEV1) of less than 1 L. All of the patients participated in a 2-week rescue program that involved optimization of drug treatment (inhaled bronchodilators and/or corticosteroids) and intensive respiratory physiotherapy. Lung function was analyzed before and after the program.


RESULTS
We evaluated 30 patients (26 men and 4 women) with a mean (SD) age of 66.7 (8.15) years and an initial FEV1 of 1.497 (0.27) mL (FEV1% of 55.7% [20.14%]). None of the patients had respiratory failure (PaO2 of 77.0 [9.4] mm Hg and PaCO2 of 41.6 [2.4] mm Hg). Twenty-four patients (80%) showed significant improvement in lung function (P< .001) after the program and were admitted for resection. Two wedge resections, 18 lobectomies, 2 pneumonectomies, and 2 exploratory thoracotomies were performed (based on oncologic indications). Nineteen of the 24 patients who underwent surgery had no complications. Two patients had prolonged air leaks, 1 empyema, and 1 hemothorax. One patient died from sepsis.


CONCLUSIONS
A large number (80%) of COPD patients previously considered unfit for surgical resection because of seriously impaired lung function can be admitted for surgery following an intensive drug and respiratory physiotherapy rescue program.
Gómez Sebastián
Guillem
G
Servicio de Cirugía Torácica, Hospital de la Santa Creu i de Sant Pau, Facultad de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain. ggomezs@hsp.santpau.es
Güell Rous
Rosa
R
González Valencia
Araceli
A
Fibla Alfara
Juan José
JJ
Estrada Saló
Gaspar
G
León González
Carlos
C
D000368:Aged; D002283:Carcinoma, Bronchogenic / Q000150:complications* / Q000601:surgery*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications* / Q000601:surgery*; D008297:Male; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications*