Thorax 1999;54:334-338 ( April )

Effect of thoracotomy and lung resection on exercise capacity in patients with lung cancer

A-M Nugent,^a I C Steele,^a A M Carragher,^b K McManus,^b J A McGuigan,^b J R P Gibbons,^b M S Riley,^a D P Nicholls^a

^a Department of Medicine, ^b Department of Thoracic Surgery, ^c Royal Victoria Hospital, Belfast BT12 6BA, UK

Correspondence to: Dr D P Nicholls.

Received 5 June 1998; Returned to authors 20 August 1998; Revised version received 10 November 1998; Accepted for publication 11 December 1998

BACKGROUNDResection is the treatment of choice for lung cancer, but may cause impaired cardiopulmonary function with an adverse effect on quality of life. Few studies have considered the effects of thoracotomy alone on lung function, and whether the operation itself can impair subsequent exercise capacity.
METHODSPatients being considered for lung resection (n = 106) underwent full static and dynamic pulmonary function testing which was repeated 3-6 months after surgery (n = 53).
RESULTSThoracotomy alone (n = 13) produced a reduction in forced expiratory volume in one second (FEV₁; mean (SE) 2.10 (0.16) versus 1.87 (0.15) l; p<0.05). Wedge resection (n = 13) produced a non-significant reduction in total lung capacity (TLC) only. Lobectomy (n = 14) reduced forced vital capacity (FVC), TLC, and carbon monoxide transfer factor but exercise capacity was unchanged. Only pneumonectomy (n = 13) reduced exercise capacity by 28% (PO₂ 23.9 (1.5) versus 17.2 (1.7) ml/min/kg; difference (95% CI) 6.72 (3.15 to 10.28); p<0.01) and three patients changed from a cardiac limitation to exercise before pneumonectomy to pulmonary limitation afterwards.
CONCLUSIONSNeither thoracotomy alone nor limited lung resection has a significant effect on exercise capacity. Only pneumonectomy is associated with impaired exercise performance, and then perhaps not as much as might be expected.

Keywords: lung cancer; thoracotomy; pneumonectomy; exercise testing

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© 1999 by Thorax
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