Ann Thorac Surg 2007;83:1139
© 2007 The Society of Thoracic Surgeons
Original Articles: General Thoracic
Invited commentary
Simon Jordan, FRCS,
Michael Polkey, MRCP,
Peter Goldstraw, FRCS
Departments of Thoracic Surgery and Respiratory Medicine, Royal Brompton Hospital, Sydney St, London, SW3 6NP United Kingdom
(Email: simon.jordan{at}rbht.nhs.uk; michael.polkey{at}rbht.nhs.uk; p.goldstraw{at}rbht.nhs.uk).
Brunelli and colleagues [1] present an interesting longitudinal study of lung function before and after lobectomy and pneumonectomy for lung cancer. The authors have demonstrated that predicted postoperative (ppo) values of forced expiratory volume in 1 second (FEV1) and carbon monoxide lung diffusion capacity (DLCO) do not correlate exactly with those values that are observed throughout the postoperative course. Although there is a degree of heterogeneity within the study group (not all patients being assessed at all time points, a 16% dropout at 3 months, some patients undergoing adjuvant chemotherapy, different methods of calculation of postoperative pulmonary function, with or without quantitative lung perfusion scan), this study does show that 3 months after surgery observed values of DLCO in patients undergoing pneumonectomy and both DLCO and FEV1 in patients undergoing lobectomy are significantly better than predicted. Furthermore, the data presented here could be used to more accurately predict the 3-month predicted pulmonary function. This information is clearly important in predicting the quality of life of patients surviving pulmonary resection. However, much of the mortality and major morbidity associated with pulmonary resection occurs in the first few days following surgery when the predicted postoperative values are more accurate in the case of pneumonectomy or overestimate the observed pulmonary function in the case of lobectomy. The findings presented here, therefore, do not necessarily negate the use of ppo FEV1 and DLCO as a means of assessing risk of surgery. These parameters were validated before the introduction of the lateral muscle-sparing thoracotomy, but not all surgeons agree that this is associated with a lower morbidity and mortality. Although it was FEV1 and DLCO that were routinely used in the preoperative assessment process, it would have been of interest to see the changes in carbon monoxide transfer coefficient (KCO) over the perioperative period. The observed increase in DLCO without change in FEV1 following pneumonectomy suggests that there is a greater redistribution of pulmonary blood flow after pneumonectomy than after lobectomy. Changes in KCO may help to clarify this.
It is also interesting to note that ppo DLCO and FEV1 underestimate the final pulmonary function in patients with chronic obstructive pulmonary disease (COPD) who are selected to undergo pulmonary resection to an even greater extent than patients without COPD. This lends further support to the concept of volume reduction benefitting selected patients with COPD undergoing pulmonary resection for lung cancer.
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- Brunelli A, Refai M, Salati M, Xiumé F, Sabbatini A. Predicted versus observed FEV1 and DLCO after major lung resection: a prospective evaluation at different postoperative periods Ann Thorac Surg 2007;83:1134-1139.[Abstract/Free Full Text]
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Predicted Versus Observed FEV1 and DLCO After Major Lung Resection: A Prospective Evaluation at Different Postoperative Periods
- Alessandro Brunelli, Majed Refai, Michele Salati, Francesco Xiumé, and Armando Sabbatini
Ann. Thorac. Surg. 2007 83: 1134-1139.
[Abstract]
[Full Text]
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