Original article: general thoracicMinimal alteration of pulmonary function after lobectomy in lung cancer patients with chronic obstructive pulmonary disease
Section snippets
Patients and methods
We retrospectively reviewed the medical records of 950 patients with non-small cell lung cancer who underwent thoracotomy and pulmonary resection between January 1990 and March 2000 at Chiba University Hospital. Of those, 816 lobectomies, 63 pneumonectomies, 20 segmentectomies, 40 partial lung resections, and 11 combined resections with lungs and major organs were performed. We focused on the 816 lobectomy cases because the anatomic and physiologic changes of residual lungs on the operative
Preoperative patient characteristics
Patient characteristics are summarized in Table 1. There were more men in the COPD group (95.8%) compared with the non-COPD group (57.7%, p < 0.001). Smoking was significantly more prevalent in the COPD group (p < 0.001). The distribution of age and body mass index were similar between the two groups. There were no statistically significant differences between the groups with respect to preoperative hypertension and cardiac diseases. Although the distribution of pathologic non-small cell lung
Comment
The frequent coexistence of COPD increases the risk of operation because of impaired postoperative ventilatory function 7, 20. Despite great advances in anesthesia, minimally invasive surgical technique, preoperative and postoperative patient management, including radical physiotherapy, bronchodilator inhalation, and incentive spirometry, COPD patients frequently have cardiopulmonary complications. Conversely, lung volume reduction improves pulmonary function in patients with severe COPD. This
Acknowledgements
We thank Eri Sekine, BS, MPH (Data Management and Biostatistics, Wyeth Lederle Japan, Ltd, Tokyo, Japan), for statistical assistance.
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2014, Journal of Thoracic and Cardiovascular SurgeryCitation Excerpt :With lobectomy, a disproportionate early loss in lung function occurs, followed by recovery of 81% to 95% of the preoperative FEV1 values by 6 to 12 months.16,17,21,22 In patients with severe heterogeneous emphysema undergoing resection of poorly functioning lung zones, the immediate postoperative period might result in only a minimal decrement or even an improvement in pulmonary function owing to the “lung volume reduction effect.”16,23-25,26 For these reasons, application of the existing recommendations, and any refinement of them using the planned procedure and degree of COPD, will rely on an accurate assessment of the ppoFEV1.