Effect of thoracotomy and lung resection on exercise capacity in patients with lung cancer
- A-M Nugenta,
- I C Steelea,
- A M Carragherb,
- K McManusb,
- J A McGuiganb,
- J R P Gibbonsb,
- M S Rileya,
- D P Nichollsa
- aDepartment of Medicine, bDepartment of Thoracic Surgery, cRoyal Victoria Hospital, Belfast BT12 6BA, UK
- Dr D P Nicholls.
- Received 5 June 1998
- Revision requested 20 August 1998
- Revised 10 November 1998
- Accepted 11 December 1998
Abstract
BACKGROUND Resection 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.
METHODS Patients 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).
RESULTS Thoracotomy 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% (PV˙o 2 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.
CONCLUSIONS Neither 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.
