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Eur J Cardiothorac Surg 2005;28:754-758
© 2005 Elsevier Science NL

Changes in pulmonary function test and cardio-pulmonary exercise capacity in COPD patients after lobar pulmonary resection

^a Division of Thoracic Surgery, Department of Surgical Science, University of Parma, U.O. Chirurgia Toracica, Azienda Ospedaliera di Parma, Viale Gramsci 14, 43100 Parma, Italy
^b Division of Respiratory Diseases, Department of Clinical Science, University of Parma, Italy
^c Department of Public Health, University of Parma, Parma, Italy

Received 25 May 2005; received in revised form 26 July 2005; accepted 2 August 2005.

^_* Corresponding author. Tel.: +39 3406874733; fax: +39 0521992019. (Email: antonio.bobbio{at}unipr.it; antonboa{at}hotmail.com).

Objective: Pulmonary Function Tests (PFT) and Cardio-Pulmonary Exercise Testing (C-PET) are useful to evaluate operability in functionally compromised patients. Although modifications of PFT and C-PET after lung surgery have been widely explored, little information exists as to modifications of exercise capacity in COPD patients undergoing lung resection. We prospectively analyzed the changes in PFT and C-PET in patients with COPD after a pulmonary lobar resection. Methods: From January 2003 to March 2004 all patients scheduled for lung resection were considered for participation in the study protocol. Those patients with a preoperative diagnosis of COPD on PFT were explored through a C-PET. Only patients who had undergone a lobar pulmonary resection were subsequently considered; these patients had a new complete cardio-respiratory evaluation 3 months after surgery. The pre- and postoperative values compared were those of FEV₁, TLC, DLCO, VO₂max, and VE/VCO₂. Data are expressed as mean ± standard deviation (SD). Statistic evaluation was made using the Wilcoxon test. Results: During this period 11 patients completed the study protocol. Ten patients underwent surgery for NSCLC and one for a pulmonary aspergilloma. Nine lobectomies and two bilobectomies were performed. In the study population, the preoperative mean value of FEV₁ resulted as being 53% (SD ± 20) of the predicted mean value, that of TLC 120% (SD ± 35) and that of DLCO 65% (SD ± 27). The preoperative mean value of VO₂max resulted as being 17.8 ml/Kg/min (SD ± 3.25) and mean VE/VCO₂ resulted as being 35.7 (SD ± 4). Three months after surgery the measured mean value of FEV₁ was 53% (SD ± 18), that of TLC was 99% (SD ± 24) and that of DLCO 52% (SD ± 18). The mean value of VO₂max resulted as being 14.1 ml/Kg/min (SD ± 3.04) and that of VE/VCO₂ was 42.5 (SD ± 12.8). Statistical analysis of PFT values showed that FEV₁ and DLCO were not significantly modified (P>0.05); in contrast, TLC had significantly decreased (P = 0.008). VO₂max had significantly decreased (P = 0.004) and VE/VCO₂ had significantly increased (P = 0.018). Conclusions: Three months after a lobar pulmonary resection, patients with COPD were found to have a significant decrease in exercise tolerance. PFT alone can underestimate the postoperative loss of exercise capacity through exercise.

Key Words: Exercise capacity • Pulmonary function • Lobectomy • COPD

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