Chest
Volume 131, Issue 1, January 2007, Pages 141-147
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Original Research: Resectional Lung Surgery
Evaluation of Expiratory Volume, Diffusion Capacity, and Exercise Tolerance Following Major Lung Resection: A Prospective Follow-up Analysis

https://doi.org/10.1378/chest.06-1345Get rights and content

Abstract

Background:Lung resections determine a variable functional reduction depending on the extent of the resection and the time elapsed from the operation. The objectives of this study were to prospectively investigate the postoperative changes in FEV1, carbon monoxide lung diffusion capacity (Dlco), and exercise tolerance after major lung resection at repeated evaluation times.

Methods:FEV1, Dlco, and peak oxygen consumption (Vo2peak) calculated using the stair climbing test were measured in 200 patients preoperatively, at discharge, and 1 month and 3 months after lobectomy or pneumonectomy. Preoperative and repeated postoperative measures were compared, and a time-series, cross-sectional regression analysis was performed to identify factors associated with postoperative Vo2peak.

Results:One month after lobectomy, FEV1, Dlco, and Vo2peak values were 79.5%, 81.5%, and 96% of preoperative values and recovered up to 84%, 88.5%, and 97% after 3 months, respectively. One month after pneumonectomy, FEV1percentage of predicted, Dlcopercentage of predicted, and Vo2peak values were 65%, 75%, and 87% of preoperative values, and were 66%, 80%, and 89% after 3 months, respectively. Three months after lobectomy, 27% of patients with COPD had improved FEV1, 34% had improved Dlco, and 43% had improved Vo2peak compared to preoperative values. The time-series, cross-sectional regression analysis showed that postoperative Vo2peak values were directly associated with preoperative values of Vo2peak, and postoperative values of FEV1and Dlco, and were inversely associated with age and body mass index.

Conclusions:Our findings may be used during preoperative counseling and for deciding eligibility for operation along with other more traditional measures of outcome.

Section snippets

Materials and Methods

Two hundred fifty-three patients were submitted to major lung resection for non-small cell lung cancer at our unit from June 2003 through December 2005 and were prospectively enrolled in this study. The study was approved by the local Institutional Review Board of the hospital, and all patients gave informed consent to participate in the study. Postoperative 30-day or in-hospital mortality was 4% (10 patients). Patients were evaluated using pulmonary function testing (PFT) and symptom-limited

Results

Table 1shows the values of the residual FEV1%, Dlco%, and Vo2peak with respect to preoperative values at different postoperative evaluation times.

In particular, 1 month after lobectomy FEV1%, Dlco%, and Vo2peak values were 79.5%, 81.5%, and 96% of preoperative values, respectively, and recovered up to 84%, 88.5%, and 97% after 3 months, respectively. One month after pneumonectomy, FEV1%, Dlco%, and Vo2peak values were 65%, 75%, and 87% of preoperative values, respectively, and were 66%, 80% and

Discussion

The objectives of the present study were to evaluate the changes of pulmonary function and exercise tolerance after major lung resection in patients with lung cancer, and to assess the factors associated with postoperative exercise capacity at repeated postoperative evaluation times. This prospective series differs from previous works on similar subjects insofar as it is a large, homogeneous group of patients treated over a relatively short period of time (30 months) at a single center,

Appendix

For the purpose of this study, a concomitant cardiac disease (cardiac comorbidity) was defined as follows: previous cardiac surgery, previous myocardial infarction, history of coronary artery disease, current treatment for hypertension, arrhythmia, or cardiac failure. All the patients with a concomitant cardiac disease underwent a specialized cardiac evaluation before performing the stair climbing test, and they were allowed to perform the test only when deemed in a hemodynamically stable

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None of the authors have any conflicts of interest to disclose.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestjournal.org/misc/reprints.shtml).

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