Chest
Volume 113, Issue 6, June 1998, Pages 1511-1516
Journal home page for Chest

Clinical Investigations: Surgery
Recovery and Limitation of Exercise Capacity After Lung Resection for Lung Cancer

https://doi.org/10.1378/chest.113.6.1511Get rights and content

Objective

To assess the effects of pulmonary resection for lung cancer on postoperative recovery and limitation of exercise capacity.

Methods

Eighty-two patients (20 pneumonectomies, 62 lobectomies) underwent spirometric pulmonary tests and exercise capacity tests preoperatively, and at 3 months and more than 6 months after the operation.

Results

In the lobectomy group, FEV1 vital capacity (VC), and maximum oxygen consumption ( V˙O2max) decreased significantly 3 months after the operation and improved after more than 6 months, but did not reach the preoperative values. In the pneumonectomy group, FEV1 VC, and V˙O2max decreased 3 months after the surgery and the values did not recover thereafter. In comparison with preoperative values, the functional percentage losses after more than 6 months for lobectomies and pneumonectomies were 11.2% and 36.1% for FEV1, 11.6% and 40.1% for VC, and 13.3% and 28.1% for V˙O2max, respectively. Postoperatively, maximal minute ventilation ( V˙Emax), the maximal heart rate percentage, and maximal O2 pulse during the exercise test significantly decreased in both the lobectomy and pneumonectomy groups. Nevertheless, VEmax and O2 pulse improved more than 6 months after lobectomy compared with the value at 3 months, but not after pneumonectomy. Breathing reserve did not differ before and after surgery in the lobectomy group, although it decreased significantly after surgery in the pneumonectomy group. Subjectively, postoperative exercise after lobectomy was limited by leg discomfort (64% at more than 6 months after surgery); after pneumonectomy, exercise was limited by dyspnea (60%).

Conclusions

These results suggest that there are differences between lobectomy and pneumonectomy for lung cancer in terms of recovery and limitation of exercise capacity.

Section snippets

MATERIALS AND METHODS

From Januay 1991 to July 1995, 115 consecutive patients with lung cancer who were considered to be candidates for lobectomy or pneumonectomy were included in the preoperative evaluation, which consisted of pulmonary function and exercise tests. After discharge from the hospital, all 115 patients who had undergone pulmonary resection were enrolled in the repeat studies. No specific postoperative rehabilitation program was provided and informed consent was obtained from all patients. Thirty-three

RESULTS

Eighty-two patients were re-evaluated at 3 months and after more than 6 months postoperatively. All 82 patients were Japanese. Two patients were receiving medications for chronic bronchitis and six for hypertension prior to surgery. Twenty patients underwent pneumonectomies and 62 underwent lobectomies. Table 1 shows preoperative comparative data on patients in both groups. The average age, sex distributions, height, weight, and spirometric pulmonary function (VC and FEV1) were comparable in

DISCUSSION

Preoperative predictability of the reductions in pulmonary function and exercise capacity after lung resection is important. However, the changes in exercise capacity do not necessarily correlate with changes in pulmonary function.4 Previous studies have reported the loss of lung function after resection.7, 8, 9, 10, 11 The postoperative pulmonary function data (FEV1 and VC) in our series are in accordance with those of Ali et al,10 who showed that after lobectomy, there was a disproportionate

References (21)

There are more references available in the full text version of this article.

Cited by (116)

View all citing articles on Scopus

Reprint requests: Kunimoto Nezu, MD, Department of Surgery III, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan 634

View full text