Predicting Loss of Pulmonary Function After Pulmonary Resection for Bronchogenic Carcinoma

doi:10.1378/chest.77.3.337

Chest

Volume 77, Issue 3, March 1980, Pages 337-342

https://doi.org/10.1378/chest.77.3.337 Get rights and content

Studies of regional pulmonary function using radioactive ¹³³xenon gas and spirometric tests (forced vital capacity and forced expiratory volume in the first second) were performed before and after unilateral pulmonary resection for cancer of the lung. Ninety-one patients were evaluated; 47 underwent total pneumonectomy, and 44 underwent lobectomy. The postoperative serial evaluations were classified into short-term and long-term studies (less than or more than three months, respectively). The preoperative and postoperative data were utilized to derive formulas for predicting an estimate of the overall functional loss after pulmonary resection based on the number of segments removed. The correlation between the predicted and measured postoperative values was good for resections involving more than three segments (r = 0.83). Prediction for smaller resections was unreliable. While both regional and overall pulmonary functions were relatively stable after pneumonectomy, there was a disproportionate early loss, followed by significant functional improvement with time following lobectomy. The anticipation of and preparation for this early loss of function may be crucial in the treatment of these patients.

Section snippets

MATERIALS AND METHODS

Studies of regional pulmonary blood flow ( $\dot{Q}$ ), ventilation ( $\dot{V}$ ), and volume (V) using radioactive ¹³³xenon gas and tests of overall pulmonary function (FVC and FEV_1.0) were performed before and after unilateral pulmonary resection for lung cancer. Ninety-one patients were studied; 47 underwent total pneumonectomy and 44 lobectomy. Thirty-one of these patients were evaluated serially at varying postoperative intervals. The studies were classified into two groups, those performed

RESULTS

Previous studies have demonstrated that both regional and overall pulmonary function are relatively stable following pneumonectomy.18, 20 The situation proved to be different in the case of our patients who underwent lobectomy, where substantial loss in function was noticed in the short-term studies. Both overall pulmonary function (FVC and FEV_1.0) and the percentage of regional function performed by the remaining lobe became significantly greater during the long-term interval after lobectomy (

DISCUSSION

Surgical resection, when feasible, offers the best treatment for patients with lung cancer. Spirometric results (FVC and FEV_1.0) provide valuable data for the screening and classification of the overall pulmonary function of these patients.20, 21, 22 Such information is occasionally helpful in deliberations concerning operability or the choice of operation in the following situations: (1) if the overall function is normal; (2) if the lung with tumor is totally airless, a situation we refer to

ACKNOWLEDGEMENT

We wish to thank Mr. David Maroongroge and Mr. Kuang-Shy Tang for their technical and statistical help and Ms. Diana Villarreal and Ms. Maxine Coufal for assembling and typing the manuscript.

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Evaluate the feasibility of lung singe photon emission computed tomography with computed tomography (SPECT-CT) before lobular resection in order to obtain an accurate predictive respiratory function for patients with pulmonary disease undergoing surgery.
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Supported by Cardiopulmonary Department research fund 110586 from the state of Texas and by grant CA 11430 from the National Cancer Institute.

Presented in part at the Twelfth International Cancer Congress, Buenos Aires, Oct 5, 1978, and the 44th Annual Scientific Assembly of the American College of Chest Physicians, Washington, DC, Nov 2, 1978.

Manuscript received March 26; revision accepted June 5.

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Chest

Clinical InvestigationsPredicting Loss of Pulmonary Function After Pulmonary Resection for Bronchogenic Carcinoma

Section snippets

MATERIALS AND METHODS

RESULTS

DISCUSSION

ACKNOWLEDGEMENT

Chest

Br J Dis Chest

Chest

Chest

J Thorac Surg

Chest

Br J Anaesth

A system for the clinical staging of lung cancer

Am J Roentgenol

The staging of lung cancer

Semin Oncol

Pulmonary function in bronchial carcinoma

Thorax

Clinical physiologic and morphologic examination of the lung in patients with bronchogenic carcinoma and the relation of the findings to postoperative deaths

Am Rev Respir Dis

Regional pulmonary function in bronchogenic carcinoma studied with xenon-133

Clin Res

Ventilatory capacity in chronic bronchitis in relation to carbon dioxide retention

Scand J Respir Dis

Clinical Investigations
Predicting Loss of Pulmonary Function After Pulmonary Resection for Bronchogenic Carcinoma