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Lung Cancer Resection^*

The Prediction of Postsurgical Outcomes Should Include Long-term Functional Results

^* From the Clinic of Respiratory Diseases (Drs. Beccaria, Corsico, Fulgoni, Zoia, Casali, and Cerveri), and Department of Surgery (Dr. Orlandoni), University of Pavia–IRCCS, Policlinico "S.Matteo", Pavia, Italy.

Correspondence to: Angelo Corsico, MD, Clinica Malattie Apparato Respiratorio, Università di Pavia–IRCCS, Policlinico "S. Matteo" via Taramelli 5, 27100 Pavia, Italy; e-mail: isa{at}mbox.systemy.it

Study objectives: To assess (1) the possibility of predicting long-term postoperative lung function, and (2) the usefulness of maximal oxygen consumption (O₂max) as a criterion for operability and as a predictor of long-term disability.

Design: Prospective study.

Setting: Outpatients and inpatients of a university hospital.

Participants: Sixty-two consecutive patients (mean ± SD age, 62 ± 8 years; 51 male and 11 female patients) were preoperatively evaluated for lung cancer resection (pneumonectomy or bilobectomy [n = 14] and lobectomy [n = 48]).

Measurements: Clinical examination and recorded respiratory symptoms and spirometry results before surgery and 6 months after surgery. If predicted postoperative FEV₁ (ppoFEV₁) was < 40%, patients underwent exercise testing; if O₂max was between 10 mL/kg/min and 20 mL/kg/min, patients underwent a split-function study.

Results: All the patients with ppoFEV₁ 40%—even those patients (26%) with FEV₁ < 80%—underwent thoracotomy without further tests. Seven patients with ppoFEV₁ < 40% underwent exercise testing, and three of them underwent a split-function study. Nine patients (15%; including six patients with COPD and one patient with asthma) had immediate postoperative complications (pneumonia [n = 5] and respiratory failure [n = 4]); seven of these patients had ppoFEV₁ 40%. ppoFEV₁ significantly underestimated the actual postoperative FEV₁ (poFEV₁; p < 0.001) 6 months after pneumonectomy or bilobectomy but was reliable for actual poFEV₁ after lobectomy. Two patients with predicted postoperative O₂max > 10 mL/kg/min became oxygen dependent and had marked limitation of daily living.

Conclusions: ppoFEV₁ 40% reliably identifies patients not requiring further tests and not at long-term risk of respiratory disability. O₂max, effective for defining the immediate surgical risk, is not useful in predicting long-term disability.

Key Words: lung neoplasms • postoperative complications • respiratory function tests • thoracotomy

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