Original article: general thoracic
Minimal alteration of pulmonary function after lobectomy in lung cancer patients with chronic obstructive pulmonary disease

https://doi.org/10.1016/S0003-4975(03)00489-2Get rights and content

Abstract

Background

The aim of this study was to evaluate the influence of chronic obstructive pulmonary diseases (COPD) on postoperative pulmonary function and to elucidate the factors for decreasing the reduction of pulmonary function after lobectomy.

Methods

We conducted a retrospective chart review of 521 patients who had undergone lobectomy for lung cancer at Chiba University Hospital between 1990 and 2000. Forty-eight patients were categorized as COPD, defined as percentage of predicted forced expiratory volume at 1 second (FEV1) less than or equal to 70% and percentage of FEV1 to forced vital capacity less than or equal to 70%. The remaining 473 patients were categorized as non-COPD.

Results

Although all preoperative pulmonary function test data and arterial oxygen tension were significantly lower in the COPD group, postoperative arterial oxygen tension and FEV1 were equivalent between the two groups, and the ratio of actual postoperative to predicted postoperative FEV1 was significantly better in the COPD group (p < 0.001). With multivariable analysis, COPD and pulmonary resection of the lower portion of the lung (lower or middle-lower lobectomies) were identified as independent factors for the minimal deterioration of FEV1. Actual postoperative FEV1 was 15% lower and higher than predicted, respectively, in the non-COPD patients with upper portion lobectomy and the COPD patients with lower portion lobectomy. Finally, we created a new equation for predicting postoperative FEV1, and it produced a higher coefficient of determination (R2) than the conventional one.

Conclusions

The postoperative ventilatory function in patients with COPD who had lower or middle-lower lobectomies was better preserved than predicted.

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.

References (28)

  • S.R. Hazelrigg et al.

    The effect of muscle-sparing versus standard posterolateral thoracotomy on pulmonary function, muscle strength, and postoperative pain

    J Thorac Cardiovasc Surg

    (1991)
  • M.S. Tockman et al.

    Airway obstruction and the risk for lung cancer

    Ann Intern Med

    (1987)
  • J. Markos et al.

    Preoperative assessment as a predictor of mortality and morbidity after lung resection

    Am Rev Respir Dis

    (1989)
  • A. Carretta et al.

    Improvement of pulmonary function after lobectomy for non-small cell lung cancer in emphysematous patients

    Eur J Cardiothorac Surg

    (1999)
  • Cited by (0)

    View full text