Ann Thorac Surg 2005;79:2197-2198
© 2005 The Society of Thoracic Surgeons
Correspondence
Pulmonary Function May Be Prognostic But Should Not Preclude Lobectomy for Lung Cancer
C.S. Pramesh, MS, FRCS,
Rajesh C. Mistry, MS,
Jaiprakash Agarwal, MD,
K. Arvind, MS
Division of Thoracic Surgery, Department of Radiotherapy, Tata Memorial Hospital, Mumbai 400012, India
(E-mail: cspramesh{at}vsnl.net).
To the Editor:
Iizasa and colleagues [1] are to be commended on an excellent study of preoperative pulmonary function as a prognostic factor for long-term survival after surgery for nonsmall cell lung cancer (NSCLC). Preoperative and predicted postoperative lung volumes have been extensively used in predicting immediate postoperative complications and respiratory insufficiency, but considering it as a prognosticator of long-term outcomes injects fresh thought into the subject. It is also interesting to note that most deaths in the study were unrelated to the primary cancer. However, to recommend avoidance of lobectomy in patients with a preoperative forced expiratory volume in 1 second (FEV1) < 70% seems a bit extreme. In their study, age, gender, and preoperative FEV1 < 70% were considered poor prognostic factors among patients with stage I NSCLC. Based on this finding the authors have recommended that "lobectomy may not be the preferred surgical modality for patients with stage I NSCLC with poor FEV1." By this logic, lobectomy should not be recommended in elderly males as well.
The morbidity of lobectomy is extremely low with no change in exercise capacity and causes insignificant reductions in FEV1, peak heart rate, oxygen consumption, minute ventilation, oxygen saturation, and respiratory exchange ratio [2]. Also patients with chronic obstructive pulmonary disease may actually have improvement of their lung function after an upper lobectomy [3]. In a decision analysis model, what needs to be determined is not the outcome of patients with FEV1 < 70% as compared with patients with a better FEV1, but rather what their outcome would have been if they have had sublobar resections. It is quite possible that the patients who died in the group who had FEV1 < 70% may have died even with sublobar resections. The Lung Cancer Study Group trial [4] showed inferior survival for sublobar resections both in their initial report as well as their updated results. Hence, to recommend a suboptimal cancer control surgery for the entire cohort of patients with FEV1 < 70% would unfairly deny these patients their best chance for cure.
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References
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- Iizasa T, Suzuki M, Yasufuku K, et al. Preoperative pulmonary function as a prognostic factor for stage I non-small cell lung cancer Ann Thorac Surg 2004;77:1896-1903.[Abstract/Free Full Text]
- Nugent AM, Steele IC, Carragher AM, et al. Effect of thoracotomy and lung resection on exercise capacity in patients with lung cancer Thorax 1999;54:334-338.[Abstract/Free Full Text]
- Korst RJ, Ginsberg RJ, Ailawadi M, et al. Lobectomy improves ventilatory function in selected patients with server COPD Ann Thorac Surg 1998;66:898-902.[Abstract/Free Full Text]
- Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer Ann Thorac Surg 1995;60:615-623.[Abstract/Free Full Text]
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