Impact on Pulmonary Function after Lobectomy in Patients with Chronic Obstructive Pulmonary Disease

Abstract

Objective: The purpose of this study was to evaluate the operative outcome and pulmonary function after lobectomy; this included systematic mediastinal and hilar lymph node dissection for primary non-small cell lung cancer or pulmonary metastases of extrapulmonary origin in patients with chronic obstructive pulmonary disease (COPD) and a preoperative FEV₁ of less than 1.5 l (< 80 % of predicted value) and FEV₁/FVC < 70 % (COPD II°). Methods: A retrospective analysis was undertaken in 79 patients who had consecutively undergone lobectomy with a preoperative FEV₁ < 1.5 l (< 80 %) and FEV₁/FVC < 70 % (COPD II°). Inclusion criteria were the ability to complete pulmonary function tests and lobectomy for malignancy. Patients with small cell lung cancer and unable to quit smoking less than 6 months prior to surgery were excluded. In 38 cases, pulmonary function tests were performed at 3 months after surgery, and 16 patients had tests at 3 and 6 months. Results: A total of 79 patients were included in this study, with a median age of 70 years (range: 45 - 85 years). The median preoperative FEV₁ was 1.3 l (range: 0.8 - 1.5 l), and patients underwent assisted ventilation for less than 1 hour after surgery (range: 0 - 214 h), and stayed for less than 24 h in the intensive care unit (range: 1 h-56 d). Three patients (3.8 %) died within 30 days after lobectomy. In 14 patients, additional treatment for surgical complications was performed (17.7 %). Follow-up after surgery revealed a significant decrease in FVC and FEV₁ (- 17 % and - 8 %, p < 0.005), but function had improved again (+ 10 % and + 11 %, p < 0.05) at 3 months after surgery and remained stable at 6 months after lobectomy. No statistically significant changes were noticed for paO₂ and paCO₂ values after surgical treatment. Conclusions: It appears that surgical resection of malignant lung tumours by lobectomy can also be performed successfully in selected patients with low FEV₁ and COPD II° without significant loss of pulmonary function.

thoracic surgery - lobectomy - COPD - pulmonary function

References

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