Chest ACCP Career Connection
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Guest Access | Sign In via User Name/Password
This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF) Free
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Article Archive
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via ISI Web of Science (12)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Beccaria, M.
Right arrow Articles by Cerveri, I.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Beccaria, M.
Right arrow Articles by Cerveri, I.
(Chest. 2001;120:37-42.)
© 2001 American College of Chest Physicians

Lung Cancer Resection*

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

Massimiliano Beccaria, MD; Angelo Corsico, MD; Paola Fulgoni, MD; Maria Cristina Zoia, MD; Lucio Casali, MD; Giulio Orlandoni, MD and Isa Cerveri, MD

* 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


   Abstract
TOP
 Abstract
Introduction
 Materials and Methods
 Results
 Discussion
 References
 
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


   Introduction
TOP
 Abstract
 Introduction
Materials and Methods
 Results
 Discussion
 References
 
Because of common etiologic factors, patients with lung cancer frequently suffer from chronic airway obstruction and/or cardiovascular diseases.1 This puts them at increased postoperative risk of permanent respiratory disability and death. More advanced surgical and perioperative care techniques have reduced immediate postoperative risks and have extended the possibility of surgical resection to even more compromised patients who, although they survive the operation, are perhaps at risk of long-term physical debility and permanent ventilator and/or oxygen dependence.2 3 4 Many patients with lung cancer are old, and pulmonary resection affects quality of life substantially.5 Chronic respiratory insufficiency as a sequela of surgery is a dramatic event that patients and their relatives can find hard to accept, and can also be a heavy socioeconomic burden. A recent editorial published in CHEST6 emphasized the need for more comprehensive preoperative evaluation and follow-up studies addressed not only to determine raw survival figures but also to assessing interim postsurgical quality of life. An important aspect has been highlighted: patients do not regard immediate postoperative complications as sufficient cause to forego important surgery, while they do consider physical debility as extremely undesirable.7 Thus, long-term functional results after resection should be considered with particular care before deciding on surgery, and the final decision should not be made without also informing patients fully about their long-term postsurgical quality of life. However, the majority of the most recent studies6 8 have tried to identify preoperative variables that can identify high-risk patients in whom surgery should not be attempted and that predict immediate postoperative morbidity for patients undergoing lung resection, and have not considered long-term outcomes.

We therefore designed a prospective study in a sample of patients undergoing lung surgery for cancer, reassessing lung function and clinical respiratory evaluation 6 months after thoracotomy. The aims of the study were to assess: (1) the possibility of a simple calculation of predicted postoperative FEV1 (ppoFEV1), based on the number of the bronchopulmonary segments removed,9 predicting long-term postoperative lung function loss; and (2) to evaluate the usefulness of maximal oxygen consumption (O2max) proposed2 8 as the final criterion for operability in predicting long-term disability.


   Materials and Methods
TOP
 Abstract
 Introduction
 Materials and Methods
Results
 Discussion
 References
 
Patient Selection and Study Protocol
We prospectively studied 93 consecutive patients with normal ECG findings and without any history of heart disease, who were sent from our surgery department to undergo a preoperative evaluation for resection of lung cancer. We chose to exclude patients with cardiovascular disease from our study because they undoubtedly had to undergo further specific clinical and functional evaluations. Thirty-one of the original 93 patients were unavailable for the follow-up study: 1 patient was considered inoperable on the basis of exercise testing and the split-function study, with his predicted postoperative O2max (ppoO2max) being < 10 mL/kg/min; 9 patients died (8 patients died at home within 6 months after surgery because of relapse, and 1 patient died immediately after surgery because of hemorrhage); 4 patients were withdrawn because they received radiotherapy or chemotherapy after the surgery; 2 patients were withdrawn because of bullectomy concomitant with lung cancer resection; and 15 patients were living too far away or refused to undergo further follow-up studies.

The mean ± SD age of the sample was 62 ± 8 years; 51 patients were male and 11 were female, 6 were nonsmokers, 30 were smokers, and 26 were ex-smokers. Clinically, the stage of lung cancer was IA/B in 25 patients, IIA/B in 28 patients, and IIIA in 9 patients, according to international stage grouping.10 Of the 51 male patients, 2 patients underwent right pneumonectomy, 9 underwent left pneumonectomy, 3 underwent right bilobectomy, 10 underwent upper right lobectomy, 2 underwent medial lobectomy, 4 underwent lower right lobectomy, 12 underwent upper left lobectomy, and 9 underwent lower left lobectomy. Out of the 11 female patients, 5 underwent upper right lobectomy, 4 underwent upper left lobectomy, and 2 underwent lower left lobectomy.

All of the 62 patients included in the study analysis underwent preoperative clinical and functional assessments in the week prior to their operation, and again 6 months later. The preoperative workup included a complete clinical examination, detailed recording of respiratory symptoms, spirometry, and a carbon monoxide diffusion test. If the ppoFEV1 was < 40% of the predicted normal value, the patients underwent exercise testing; and, as suggested by Wyser et al,8 when O2max was between 10 mL/kg/min and 20 mL/kg/min, they also underwent a split-function study to determine their ppoO2max. This criterion is commonly reported in the recent literature as identifying high-risk patients.2 All patients were followed up prospectively after surgery, and respiratory complications occurring during the patient’s hospitalization were recorded. For the purposes of this study, we considered pneumonia, atelectasis, and respiratory failure as respiratory complications. Six months after surgery, the patients again underwent a complete clinical examination, and respiratory symptoms and results of spirometry were recorded.

Pulmonary Function Tests
Lung volumes were measured by a water-sealed spirometer (Pulmonet III; Sensor Medics; Anaheim, CA). Measurements were performed according to the European Community for Coal and Steel statements11 and to the American Thoracic Society recommendations.12 The best FVC measurement was recorded, as was the FEV1 and the FEV1/FVC ratio. Obstruction was defined as FEV1/FVC < 88% predicted.13

Diffusion capacity of the lung for carbon monoxide (DLCO) was determined using the single-breath method (Transferscreen-II; Jaeger; Wuerzburg, Germany) and corrected for hemoglobin content. Since the correction of DLCO for alveolar volume did not influence the results of our analysis, only uncorrected DLCO values are reported. Measurements were performed according to the European Community for Coal and Steel11 and American Thoracic Society12 guidelines.

ppoFEV1
ppoFEV1 was obtained using preoperative pulmonary function testing data and information on the number of bronchopulmonary segments removed (which can usually be predicted on the basis of preoperative radiologic studies). ppoFEV1 was calculated using the following formula: ppoFEV1 = poFEV1 x (1 - [S x 5.26]/100), where S = number of bronchopulmonary segments removed, and poFEV1 = postoperative FEV1.9 14 15 The right and left lower lobes were considered to have five bronchopulmonary segments, the right middle lobe had two bronchopulmonary segments, the right upper lobe had three bronchopulmonary segments, and the left upper lobe had four bronchopulmonary segments.

Exercise Testing
Exercise capacity was determined by an incremental exercise test on a cycle ergometer with breath-by-breath analysis of gas exchange (Vmax 29C; Sensor Medics). Baseline measurements were recorded after a resting period of at least 3 min on the bicycle. The exercise protocol consisted of a 1-min warm-up period and a 10-W/min workload increase until the patient was unable to continue because of the severity of dyspnea or leg discomfort. Heart rate, ECG, and hemoglobin oxygen saturation were monitored during the exercise study. Continuous measurements of ventilation, O2, carbon dioxide production, and pulse rate were averaged every 10 s. O2max was defined as the highest oxygen consumption achieved during the exercise test.

Split-Function Studies
Split-function studies of regional pulmonary function were performed using 99mTc lung perfusion scans. The studies were performed with the patient in a seated upright position and breathing normally at rest. The postoperative exercise capacity was calculated by the fractional contribution of the lung tissue to be resected to overall lung function using the following formula: ppoO2max = preoperative O2max x (1 - fractional contribution of tissue to be resected).

Data Analysis
All values are presented as mean ± SD. Differences between actual poFEV1 and ppoFEV1 were tested by the paired Student’s t test. Values of p < 0.05 were considered statistically significant. Differences between actual poFEV1 and ppoFEV1 were also compared using linear correlation analysis. Pneumonectomy and bilobectomy were considered together in the analyses.


   Results
TOP
 Abstract
 Introduction
 Materials and Methods
 Results
Discussion
 References
 
Table 1 reports the baseline mean values and SDs of total lung capacity (TLC), FVC, FEV1, FEV1/FVC, and DLCO for all the patients included in the study. Twenty-six patients (42%) had a history of chronic bronchitis and showed an obstructive pattern with a mean FEV1/FVC of 81 ± 13% of predicted; 23% of them also had hyperinflation (TLC, 123 ± 7% of predicted). One patient had bronchial asthma with normal lung function. Eight patients (13%) reported dyspnea on exertion. Eighteen patients (29%) showed the presence of atelectasis or hilar disease or endobronchial involvement with radiologic signs of dysventilation; 8 of these patients had COPD. None of our patients had radiographic evidence of interstitial disease, and the impairment of DLCO-–when found—could be explained by the presence of COPD and/or atelectasis.


View this table:
[in this window]
[in a new window]

  		Table 1. Baseline Pulmonary Function Data*

 
Table 2 shows the mean values and SDs of ppoFEV1 and ppoFEV1 percentage of the predicted normal value for the whole sample, and separately for patients who underwent pneumonectomy or bilobectomy and for those who underwent lobectomy. Seven patients (11%) had ppoFEV1 < 40% of the predicted normal value, the threshold considered to identify high-risk patients. All of these patients then carried out an exercise test: four patients had a O2max > 20 mL/kg/min, and they were scheduled for surgery; three patients had a O2max between 10 mL/kg/min and 20 mL/kg/min and underwent a split-function study to determine their predicted postoperative lung function. Since their ppoO2max was > 10 mL/kg/min, they were accepted for thoracotomy. Of these seven patients, two patients with peripheral lung cancer and COPD underwent lobectomy, and five patients with atelectasis underwent pneumonectomy (three of these patients also had COPD).


View this table:
[in this window]
[in a new window]

  		Table 2. ppoFEV1 as a Percent of the Predicted Normal Value and as an Absolute Value, and FEV1 6 Months After Surgery (Actual poFEV1) in the Whole Sample, in Patients Who Underwent Pneumonectomy or Bilobectomy, and in Those Who Underwent Lobectomy*

 
Nine patients (15%; six patients with COPD) developed immediate bronchopulmonary postoperative complications. Five of the nine patients had pneumonia, and the other four patients (including one patient with asthma and two patients with COPD) had acute respiratory failure requiring mechanical ventilation. Seven of these patients who suffered immediate postoperative complications had ppoFEV1 >= 40% of the predicted normal value; the two COPD patients with acute respiratory failure had ppoFEV1 < 40%. The mean hospital stay of all patients was 17 ± 11 days, and that of the patients with respiratory complications was 52 ± 3 days.

The mean values and SDs of ppoFEV1 and actual poFEV1 measured 6 months after surgery, for the whole sample and separately for patients who underwent lobectomy and for those who underwent pneumonectomy or bilobectomy, are given in Table 2 . Figures 1 , 2 show the linear correlation between ppoFEV1 and actual poFEV1, respectively, in patients who underwent lobectomy and in those who underwent pneumonectomy or bilobectomy. ppoFEV1 was reliable for all the patients who underwent lobectomy, while it differed significantly from the actual poFEV1 (p < 0.001) in all the patients who underwent pneumonectomy or bilobectomy. Likewise, ppoFEV1 was significantly different from the actual poFEV1 (p < 0.01) in the subgroup of patients with atelectasis or hilar disease or endobronchial involvement. Half of these subjects had undergone pneumonectomy or bilobectomy. Considering separately subjects with atelectasis who underwent pneumonectomy or bilobectomy and those who underwent lobectomy, ppoFEV1 significantly underestimated the actual poFEV1 only in the former group (Table 3 ).



View larger version (16K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 1. Relationship between ppoFEV1 and FEV1 6 months after surgery (actual poFEV1) in the patients who underwent lobectomy. Open triangles represent subjects with atelectasis or hilar disease or endobronchial involvement with radiologic signs of dysventilation. The regression line (slope = 0.75) for pooled patients is shown. The dotted line represents the identity.

 

View this table:
[in this window]
[in a new window]

  		Table 3. ppoFEV1 and FEV1 6 Months After Surgery (Actual poFEV1) in Subjects With Atelectasis Who Underwent Pneumonectomy or Bilobectomy and in Those Who Underwent Lobectomy*

 
Generally, our patients did not experience appreciable worsening of respiratory symptoms 6 months after thoracotomy. Four of seven patients with ppoFEV1 < 40% of the predicted normal value and O2max > 20 mL/kg/min, who underwent pneumonectomy, had a much higher actual poFEV1 than that predicted and did not have appreciable worsening of their respiratory symptoms. Two of the three other patients with ppoFEV1 < 40% of the predicted normal value and ppoO2max > 10 mL/kg/min, who reported dyspnea on exertion during the preoperative clinical evaluation, at the assessment 6 months after surgery complained of severe dyspnea, were oxygen dependent, and had marked limitation in performing activities of daily living. One of them underwent pneumonectomy and the other a lobectomy; in both patients, the actual value was almost identical to the ppoFEV1, below 1 L. The third subject, who underwent lobectomy, again had an actual value very accurately predicted by ppoFEV1—just > 1 L—but did not report relevant worsening of dyspnea.

Because a large number of patients (31 of 93 patients) in this study were unavailable for follow-up, we report baseline pulmonary function data and ppoFEV1 for this group (Table 4) . Four of these patients (13%) had ppoFEV1 < 40% of the predicted normal value and underwent an exercise test: two patients had a O2max > 20 mL/kg/min and they were scheduled for surgery, and two patients had a O2max between 10 mL/kg/min and 20 mL/kg/min and underwent a split-function study. One of them was considered inoperable on the basis of exercise testing results and the split-function study. Six patients (19%) developed immediate bronchopulmonary postoperative complications (pneumonia and/or acute respiratory failure), and one of them died immediately after surgery because of hemorrhage. These patients that were unavailable for the follow-up study had preoperative pulmonary function data, immediate surgical risk, and immediate complications similar to the 62 patients included in the study analysis.


View this table:
[in this window]
[in a new window]

  		Table 4. Baseline Pulmonary Function Data and ppoFEV1 of the 31 Patients Who Were Unavailable for the Follow-up Study*

 

   Discussion
TOP
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
References
 
The main result of our study is that the simple calculation of ppoFEV1 correlated well with the actual poFEV1 value 6 months after surgery in all the patients who underwent lobectomy. However, this was not the case for patients who underwent pneumonectomy; in fact, in these patients, ppoFEV1 consistently underestimated the actual poFEV1 by an average of 500 mL. This finding is consistent with data previously presented by Zeiher et al.14 Even in subjects with atelectasis or hilar disease or endobronchial involvement with radiologic signs of dysventilation, the simple calculation of ppoFEV1 is not reliable.16 However, among these patients, only in those who underwent pneumonectomy did ppoFEV1 not correlate with the actual postoperative value. The bias was always an underestimation with respect to the actual poFEV1. On the basis of these results, we can state that ppoFEV1 based on the simple calculation is reliable, when >= 40% of the predicted normal value, in identifying patients who can undergo lung resection without further tests and without long-term risk of respiratory disability. In the algorithm proposed by Wyser et al,8 patients with FEV1 and DLCO < 80% predicted were considered to require further tests. In our sample, 16 patients (26%) had FEV1 < 80% but ppoFEV1 >= 40% of the predicted normal value; according to Wyser et al,8 these patients should undergo further tests, whereas such a test can, in fact, be avoided on the basis of the simple calculation of ppoFEV1. This is particularly important because these studies are expensive, time-consuming, and not readily available in all hospitals, while the number of patients needing lung resection is increasing and the delay between preoperative evaluation and surgery may worsen prognosis.

None of our subjects with ppoFEV1 >= 40% of the predicted normal values had long-term complications. ppoFEV1, besides being easy, simple, and cost saving and time saving, also offers a useful measurement for evaluating residual lung function. There was only a 15% short-term incidence of pulmonary complications after thoracotomy in our sample; this is consistent with results from other studies.8 9 Four of our five patients with pneumonia had COPD; one of the two patients with acute respiratory failure requiring mechanical ventilation was asthmatic with normal preoperative lung function. Many factors may contribute to the risk of postoperative complications, including smoking, poor general health status, older age, obesity, COPD, and asthma.17 A variety of indexes have been tested in attempts to predict pulmonary complications, but without definitive results having been reached.3 8 9 18 One of the difficulties encountered in analyzing the literature on preoperative pulmonary testing arises from a lack of consensus about what constitutes a postoperative pulmonary complication.4 Our sample was a selected one, being composed of subjects without cardiac comorbidity in whom resection was planned after evaluation of operative factors. Unfortunately, because of the small number of our subjects with complications, we could not perform a multivariate analysis. From our results, we can only argue that, independently of lung function, concomitant respiratory diseases—very common in these patients—play an important role in determining the onset of perioperative pulmonary complications.

All seven patients with ppoFEV1 < 40% of the predicted normal value were operated on, their surgical risk having been defined as acceptable on the basis of the further tests proposed by Wyser et al.8 What is an acceptable surgical risk in a disease with high mortality is, however, still an open problem,19 even if some functional cut-off values are now available.2 Olsen4 concludes an editorial by stating, "do what you and your center do best... but treat the patient." There is consensus in literature that resections not exceeding one lobe lead to very little permanent functional deficit, whereas pneumonectomies cause a permanent deficit that is greater for pulmonary function than for exercise capacity.20 However long-term problems are possible even following lobectomy if the functional situation is already critical before surgery.

As far as long-term respiratory disability is concerned, our results document that two of seven patients with ppoFEV1 < 40% of the predicted normal value and ppoO2max > 10 mL/kg/min, thus with acceptable surgical risk, developed chronic respiratory failure, were oxygen dependent with severe dyspnea, and had a very poor quality of life. The cut-off values we used according to Wyser et al,8 effective for defining the immediate surgical risk, were not able to predict long-term disability in our two patients. One of these patients had only lobectomy, and even the low permanent loss in pulmonary function caused by lobectomy can be sufficient to cause severe worsening of symptoms. Indeed, it is well-known that dyspnea ratings and lung function are separate factors that independently characterize the condition of patients with COPD, even if there is a significant correlation between them.21 Although there are studies that describe quality-of-life issues, predictors of debility, and other poor outcomes, they have gained little attention, especially as applied to pulmonary patients with severe impairment.7 In any case, their results are mixed and, moreover, they did not test the more recently proposed lung function indexes as predictors.4 22 23 24 Therefore, we emphasize the need for selective studies on severely ill patients, using appropriate tools, such as a dyspnea scale and questionnaires on quality of life, to evaluate long-term results.

In conclusion, we suggest that the ppoFEV1 can be used as a first-line test to define patients as having a low risk for surgery and for long-term complications. While awaiting validation studies of new cut-off points to predict long-term risks, patients defined as having a short-term, high—but acceptable—risk for surgery should be informed on the possible long-term consequences of thoracotomy. The final decision should be made only after discussing their transient state and the intermediate and long-term scenario after surgery with the patients.



View larger version (13K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 2. Relationship between ppoFEV1 and FEV1 6 months after surgery (actual poFEV1) in the patients who underwent pneumonectomy or bilobectomy. Open triangles represent subjects with atelectasis or hilar disease or endobronchial involvement with radiologic signs of dysventilation. The regression line (slope = 0.29) for pooled patients is shown. The dotted line represents the identity.

 

   Acknowledgements
 
We thank Dr. Rachel Stenner for assistance in preparation of the article.


   Footnotes
 
Abbreviations: DLCO = diffusion capacity of the lung for carbon monoxide; poFEV1 = postoperative FEV1; ppoFEV1 = predicted postoperative FEV1; ppoO2max = predicted postoperative maximal oxygen consumption; TLC = total lung capacity; O2max = maximal oxygen consumption

Received for publication August 11, 2000. Accepted for publication February 14, 2001.


   References
TOP
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 

  1. Ganz, PA (1993) Age and gender as factors in cancer therapy. Clin Geriatr Med 9,145-155[Medline]
  2. Reilly, JJ, Jr (1999) Evidence-based preoperative evaluation of candidates for thoracotomy. Chest 116,474S-476S[Abstract/Free Full Text]
  3. Ferguson, MK (1999) Preoperative assessment of pulmonary risk. Chest 115,58S-63S[Abstract/Free Full Text]
  4. Olsen, GN (1998) Physiology of lung resection. Chest 113,1438-1439[Free Full Text]
  5. Kurtz, ME, Kurtz, JC, Stommel, M, et al (1997) Loss of physical functioning among geriatric cancer patients: relationship to cancer site, treatment, comorbidity and age. Eur J Cancer 33,2352-2358
  6. Rocco, G (2000) Outcome of lung surgery: what patients don’t like[editorial]. Chest 117,1531-1532[Free Full Text]
  7. Cykert, S, Kissling, G, Hansen, CJ (2000) Patient preferences regarding possible outcomes of lung resection: what outcomes should preoperative evaluations target? Chest 117,1551-1559[Abstract/Free Full Text]
  8. Wyser, C, Stulz, P, Solèr, M, et al (1999) Prospective evaluation of an algorithm for the functional assessment of lung resection candidates. Am J Respir Crit Care Med 159,1450-1456[Abstract/Free Full Text]
  9. Kearney, DJ, Lee, TH, Reilly, JJ, et al (1994) Assessment of operative risk in patients undergoing lung resection: importance of predicted pulmonary function. Chest 105,753-759[Abstract/Free Full Text]
  10. . American Thoracic Society, and European Respiratory Society (1997) Pretreatment evaluation of non-small cell lung cancer. Am J Respir Crit Care Med 156,320-332[Free Full Text]
  11. Quanjer, PH, Tammeling, GJ, Cotes, JE, et al (1993) Report Working Party: standardization of lung function tests. Eur Respir J 6(suppl 16),5-40[Medline]
  12. . American Thoracic Society. (1995) Standardization of spirometry. Am J Respir Crit Care Med 152,1107-1136[ISI][Medline]
  13. . American Thoracic Society. (1991) Lung function testing: selection of reference values and interpretative strategies. Am Rev Respir Dis 144,1202-1218[ISI][Medline]
  14. Zeiher, BG, Gross, TJ, Kern, JA, et al (1995) Predicting postoperative pulmonary function in patients undergoing lung resection. Chest 108,68-72[Abstract/Free Full Text]
  15. Wernly, JA, DeMeester, TR, Kirchner, PT, et al (1980) Clinical value of quantitative ventilation-perfusion lung scans in the surgical management of bronchogenic carcinoma. Thorac Cardiovasc Surg 80,535-543
  16. Zoia, MC, Corsico, A, Vitulo, P, et al (1997) Prediction of FEV1 reductions in patients undergoing pulmonary resection. Monaldi Arch Chest Dis 53,259-261
  17. Smetana, GW (1999) Preoperative pulmonary evaluation. N Engl J Med 340,937-944[Free Full Text]
  18. Pierce, RJ, Copland, JM, Sharpe, K, et al (1994) Preoperative risk evaluation for lung cancer resection: predicted postoperative product as a predictor of surgical mortality. Am J Respir Crit Care Med 150,947-955[Abstract]
  19. Gass, GD, Olsen, GN (1986) Preoperative pulmonary function testing to predict postoperative morbidity and mortality. Chest 89,127-135[Free Full Text]
  20. Bolliger, CT, Perruchoud, AP (1988) Functional evaluation of the lung resection candidate. Eur Respir J 11,198-212
  21. Hajiro, T, Nishimura, K, Tsukino, M, et al (1998) Analysis of clinical methods used to evaluate dyspnea in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 158,1185-1189[Abstract/Free Full Text]
  22. Bousamra, M, II, Presberg, K, Chammas, J, et al (1996) Early and late morbidity in patients undergoing pulmonary resection with low diffusion capacity. Ann Thorac Surg 62,968-975[Abstract/Free Full Text]
  23. Wang, J, Olak, J, Ultman, R, et al (1999) Assessment of pulmonary complications after lung resection. Ann Thorac Surg 67,1444-1447[Abstract/Free Full Text]
  24. Dales, R, Belanger, R, Shamji, F, et al (1994) Quality-of-life following thoracotomy for lung cancer. J Clin Epidemiol 47,1443-1449[CrossRef][ISI][Medline]



This article has been cited by other articles:


Home page
 Am. J. Respir. Crit. Care Med.Home page
O. Schussler, M. Alifano, H. Dermine, S. Strano, A. Casetta, S. Sepulveda, A. Chafik, S. Coignard, A. Rabbat, and J.-F. Regnard
Postoperative Pneumonia after Major Lung Resection
Am. J. Respir. Crit. Care Med., May 15, 2006; 173(10): 1161 - 1169.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
M. J. Licker, I. Widikker, J. Robert, J.-G. Frey, A. Spiliopoulos, C. Ellenberger, A. Schweizer, and J.-M. Tschopp
Operative mortality and respiratory complications after lung resection for cancer: impact of chronic obstructive pulmonary disease and time trends.
Ann. Thorac. Surg., May 1, 2006; 81(5): 1830 - 1837.
[Abstract] [Full Text] [PDF]

Home page
 RadiologyHome page
Y. Ohno, H. Hatabu, T. Higashino, M. Nogami, D. Takenaka, H. Watanabe, M. Van Cauteren, M. Yoshimura, M. Satouchi, Y. Nishimura, et al.
Oxygen-enhanced MR Imaging: Correlation with Postsurgical Lung Function in Patients with Lung Cancer
Radiology, August 1, 2005; 236(2): 704 - 711.
[Abstract] [Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF) Free
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Article Archive
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via ISI Web of Science (12)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Beccaria, M.
Right arrow Articles by Cerveri, I.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Beccaria, M.
Right arrow Articles by Cerveri, I.

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS