Elsevier

The Annals of Thoracic Surgery

Volume 76, Issue 6, December 2003, Pages 1821-1827
The Annals of Thoracic Surgery

Original article: general thoracic
Quality of life after tailored combined surgery for stage I non–small-cell lung cancer and severe emphysema

https://doi.org/10.1016/S0003-4975(03)01302-XGet rights and content

Abstract

Background

We analyzed the early and long-term quality of life changes occurring in 16 patients undergoing tailored combined surgery for stage I non–small-cell lung cancer (NSCLC) and severe emphysema.

Methods

Mean age was 65 ± 5 years. All patients had severe emphysema with severely impaired respiratory function and quality of life. Tumor resection was performed with sole lung volume reduction (LVR) in 5 patients, separate wedge resection in 3 patients, segmentectomy in 2 patients, and lobectomy in 6 patients. A bilateral LVR was performed in 5 patients. Quality of life was assessed at baseline and every 6 months postoperatively by the Short-form 36 (SF-36) item questionnaire.

Results

Mean follow-up was 44 ± 21 months. All tumors were pathologic stage I. There was no hospital mortality nor major morbidity. Significant improvements occurred for up to 36 months in the general health (p = 0.02) domain and for up to 24 months in physical functioning (p = 0.02), role physical (p = 0.005), and general health (p = 0.01) SF-36 domains. Associated improvements regarded dyspnea index (−1.3 ± 0.6) forced expiratory volume in one second (+0.28 ± 0.2L), residual volume (−1.18 ± 0.5L) and 6-minute-walking test distance (+86 ± 67 m). Actuarial 5-year survival was similar to that of patients with no cancer undergoing LVRS during the same period (68% vs 82%, p = not significant).

Conclusions

Our study suggests that selected patients with stage I NSCLC and severe emphysema may significantly benefit from tailored combined surgery in terms of long-term quality of life and survival.

Section snippets

Material and methods

Between October 1995 and December 2002, out of 148 lung volume reductions performed at our institution, 16 patients had a combined resection of emphysema and NSCLC. Of these, 11 were referred for the suspicion of lung cancer, while in 5 patients the tumor was incidentally discovered during preoperative workup for LVR. In all instances, a rigorous preoperative assessment was carried out including digital chest roentgenogram, total body spiral computed tomography (CT), postbronchodilator

Results

Mean age was 65 ± 5 years. All patients fulfilled standard inclusion criteria for LVR. In particular, all patients had emphysema graded as severe and diffuse with disabling symptoms despite maximized medical therapy, while no patient had isolated giant bullous emphysema.

Among 9 patients who were on long-term oxygen therapy, 6 had only nocturnal oxygen therapy and 3 had continuous oxygen therapy. Internal consistency of the SF-36 questionnaire at baseline and 6 months was satisfactory (0.80 to

Comment

The World Health Organization defines HRQOL as an individual perception of their position in life in the context of the cultural and value system in which they live, and in relation to their goals, expectations, standards, and concerns. Yet, measuring HRQOL has been addressed to a multidimensional subjective assessment of feelings and wellness and satisfaction, as well as perceptions of impairments and problems [18].

Patients with severe emphysema experience negative changes in mood and social

Acknowledgements

This study was supported partially by the Ministero dell'Universitá e della Ricerca (MIVR) (Grant COFIN #9906274194-06 and 2001061131-001); by the Cousiglio Nazionale delle Richerche (Single Project 2002 CNR CU0100935CT26), and by the Progetto Ministero dells Salute-Regione Lazio 2002.

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