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Robert J. Korst
Robert J. Ginsberg
Maneesh Ailawadi
Manjit S. Bains
Robert J. Downey, Jr
Valerie W. Rusch
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Ann Thorac Surg 1998;66:898-902
© 1998 The Society of Thoracic Surgeons

Original articles: General Thoracic

Lobectomy improves ventilatory function in selected patients with severe COPD1

Robert J. Korst, MDa, Robert J. Ginsberg, MDa, Maneesh Ailawadi, MDa, Manjit S. Bains, MDa, Robert J. Downey, Jr, MDa, Valerie W. Rusch, MDa, Diane Stover, MDb

a Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
b Pulmonary Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA

Address reprint requests to Dr Ginsberg, Thoracic Service, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021
e-mail: (Ginsberr{at}mskcc.org)

Presented at the Thirty-fourth Annual Meeting of The Society of Thoracic Surgeons, New Orleans, LA, Jan 26–28, 1998.

Background. Patients often undergo limited resection instead of lobectomy for non–small cell lung cancer because of a low preoperative forced expiratory volume in 1 second (FEV1). Our goal is to define criteria that will preoperatively identify a group of patients who will not lose further function after lobectomy.

Methods. Patients who underwent lobectomy with a preoperative FEV1 of less than 80% of predicted were retrospectively identified. Data collected included preoperative and postoperative pulmonary function tests, age, sex, the lobe resected, and preoperative ventilation–perfusion scan result.

Results. Thirty-two patients were included in this study. The median preoperative FEV1 was 60% of predicted (1.65 L) and the mean change in FEV1 was a loss of 7.8% after lobectomy. The patients were divided into two groups. Group 1 (n = 13) had a preoperative FEV1 of less than or equal to 60% of predicted (median, 49%; 1.35 L) combined with an FEV1 to forced vital capacity ratio of less than or equal to 0.6. Group 2 (n = 19) includes all other patients (median preoperative FEV1, 69% of predicted; 1.87 L). The mean changes in FEV1 after lobectomy were +3.7% and -15.7% for groups 1 and 2, respectively (p < 0.005). A chronic obstructive pulmonary disease index was defined and then calculated for each patient. The relationship between this index and the change in FEV1 after lobectomy for all 32 patients appears linear (r = -0.43; p = 0.015).

Conclusions. Patients with a very low preoperative FEV1 and FEV1 to forced vital capacity ratio are less likely to lose ventilatory function after lobectomy and may actually improve it.




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