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Ann Thorac Surg 1998;65:314-318
© 1998 The Society of Thoracic Surgeons

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Original Articles: General Thoracic

Lung Reduction Operation and Resection of Pulmonary Nodules in Patients With Severe Emphysema

Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, Columbia-Presbyterian Medical Center, New York, New York USA
Division of Pulmonary Medicine, Columbia University College of Physicians and Surgeons, Columbia-Presbyterian Medical Center, New York, New York, USA

Accepted for publication July 29, 1997.

Dr Ginsburg, Columbia-Presbyterian Medical Center, 161 Fort Washington Ave, Rm 310, New York, NY 10032.

Background. Severe pulmonary dysfunction has been considered a relative contraindication to surgical resection in patients with solitary pulmonary nodules. We report our initial experience with the combined use of lung volume reduction operation and tumor resection in this patient population.

Methods and Patients. Between January 1995 and July 1996, 14 patients underwent combined lung volume reduction operation and pulmonary nodule resection. Ten (71%) patients were oxygen dependent, 5 (36%) had a room air partial pressure of carbon dioxide 45, and 5 (36%) were steroid dependent preoperatively. Mean preoperative pulmonary function tests included a forced expiratory volume in 1 second of 680 ± 98 mL (24% ± 5% predicted), forced vital capacity of 54% ± 5% predicted, and a forced expiratory volume in 1 second to vital capacity ratio of 37% ± 2% predicted.

Results. Sixteen lesions were resected in the 14 patients and included 9 non-small cell carcinomas. There was one postoperative death. All other patients are alive and well through a mean follow-up of 22.6 ± 2.3 months (12 to 35 months). At 6-month follow-up improvements were noted in dyspnea index, forced expiratory volume in 1 second forced vital capacity, and 6-minute walk distance. Mediastinal recurrence at 12-month follow-up developed in 1 patient with two separate bronchioalveolar carcinomas.

Conclusions. Simultaneous lung volume reduction operation and tumor resection should be considered in patients with emphysema with marginal reserve in the hope of maximizing postoperative lung function.

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