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The Annals of Thoracic Surgery, Vol 56, 769-771, Copyright © 1993 by The Society of Thoracic Surgeons

ARTICLES

Limited resection of bronchogenic carcinoma in the patient with impaired pulmonary function

JI Miller Jr
Division of Thoracic Surgery, Emory University School of Medicine, Emory Clinic, Atlanta, Georgia 30308.

Surgical resection is the treatment of choice for non-small cell carcinoma of the lung. In some patients with marked impairment of pulmonary function, cardiac disease, or other medical conditions, the surgeon is faced with performing either a limited resection or carrying out nonoperative therapy. Impaired pulmonary functions are defined as a maximum breathing capacity (MBC) of 35% to 40% of predicted; forced expiratory volume in 1 second (FEV1) of less than 1 L; and a forced expiratory volume 25%-75% (FEV25-75) of less than 0.6 L. When MBC values are less than 35% of predicted; the FEV1 is less than 0.6 L; and the FEV25-75 is less than 0.6 L, elective resection is contraindicated. Useful criteria for indicating an elective limited resection include the following: (1) T1 lesion, (2) peripheral location, (3) margins easily encompassed by resection, and (4) no gross lymph node involvement. In a study of 67 patients, there was 1 postoperative death, with less than an 80% 2-year survival and a 31% 5-year survival. The role of video-assisted thoracoscopy in the management of primary lung cancer remains to be defined. When the high-risk patient can be operated on with attendant low morbidity and mortality, I believe, at the current time, a video-assisted thoracic resection for primary lung cancer is not the best option, as the patient will be offered a compromised operation, and I suspect follow-up studies will prove this correct.

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