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Effect of Lung Resection on Exercise Capacity and on Carbon Monoxide Diffusing Capacity During Exercise^*

^* From the Section of Respiratory Medicine (Dr. J-S Wang), E-Da Hospital, Kaohsiung, Taiwan; Division of Respiratory Medicine (Dr. Abboud), University of British Columbia, Vancouver, BC, Canada; and the Division of Emergency Medicine (Dr. L-M Wang), Taipei Veterans General Hospital, Taipei, Taiwan.

Correspondence to: Jeng-Shing Wang, MD, MSc, 166 Min-Shiang St, Kaohsiung, Taiwan 800; e-mail: wangjs6{at}hotmail.com

Abstract

Objective: To evaluate the effect of lung resection on lung function and exercise capacity values, including diffusion capacity of the lung for carbon monoxide (DLCO), during exercise, and to determine whether postoperative lung function, including exercise capacity and DLCO during exercise, could be predicted from preoperative lung function and the number of functional segments resected.

Design: Prospective study.

Setting: Clinical pulmonary function laboratory in a university teaching hospital.

Patients: Twenty-eight patients undergoing lung resection at Vancouver General Hospital from October 1998 to May 1999, were studied preoperatively and 1-year postoperatively.

Interventions: We determined FEV₁ and FVC, and maximal oxygen uptake (O₂max) and maximal workload (Wmax) achieved during incremental exercise testing. We used the three-equation modification of the single-breath DLCO technique to determine DLCO at rest (RDLCO) and during steady-state exercise at 70% of Wmax, and the increase in DLCO from rest to exercise (ie, the mean increase in DLCO percent predicted at 70% of Wmax from resting DLCO percent predicted [(70%-R)DLCO]). We calculated the predicted postoperative (PPO) values for all the above parameters using the preoperative test data and the extent of functioning bronchopulmonary segments resected, and compared the results with the actual 1-year postoperative results.

Results: Following lung resection, there was a significant reduction in FEV₁, FVC, and DLCO with decreases of 12%, 13%, and 22% predicted, respectively. There were also significant decreases in O₂max per kilogram of 2.1 mL/min/kg (8% of predicted O₂max) and in Wmax of 12 W (7% of predicted Wmax). However, (70%-R)DLCO did not significantly decrease after lobectomy but decreased after pneumonectomy. The calculated PPO values significantly underestimated postoperative values after pneumonectomy but were acceptable for lobectomy.

Conclusions: Exercise tests may be better indicators of functional capacity after lung resection than measurements of FEV₁ and FVC or RDLCO. PPO results calculated by estimating the functional contribution of the resected segments, are comparable with those obtained using ventilation-perfusion lung scanning and significantly underestimate postoperative lung function after pneumonectomy, but are acceptable for lobectomy.

Key Words: exercise capacity • exercise diffusing capacity of the lung for carbon monoxide • lung function • lung resection • predicted postoperative value