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Long-term respiratory functional results after pneumonectomy

^a Thoracic Surgery Unit, University Hospital of Siena, Italy
^b Thoracic Surgery Unit, S.Croce e Carle Hospital, Via Coppino 26, 53100 Cuneo, Italy

Received 4 September 2007; received in revised form 10 March 2008; accepted 31 March 2008.

^_* Corresponding author. Tel.: +39 0 347 8921339; fax: +39 0 171 642491. (Email: luzzi.luca{at}virgilio.it).

Introduction: The aim of this study is to evaluate the long-term respiratory outcome of patients who underwent pneumonectomy for non-small cell lung cancer (NSCLC), analysing functional tests. Materials and methods: Twenty-seven consecutive patients who were candidates for pneumonectomy performed spirometry before and at least 24 months after surgery in the same laboratory. Diffusion of carbon monoxide and the most common dynamic and static lung volumes were evaluated in percentage of predicted and compared. Results: A significant inverse correlation was observed between the preoperative FEV1 (%) and FVC (%) and their postoperative loss, respectively r = –641 (p < 0.0001) and r = –789 (p < 0.0001). Also the correlation between the RV/TLC ratio and the FEV1 loss confirmed a better postoperative outcome in patients with major airway obstruction (p = 0.02). To investigate these data, the series were divided into two groups: group A included BPCO patients with a FEV1 lower than 80%, the others were considered group B. Group B showed a significant major postoperative FEV1 (%) and FVC (%) impairment, 31% versus 12%, p = 0.005, and FVC (%) loss, 37% versus 16% (p = 0.02), meanwhile group A showed a significant major postoperative RV (%) reduction, 43% versus 17%, p = 0.03. Despite being significantly higher preoperatively in BPCO patients, the RV% becomes similar between the two groups in the postoperative. Conclusions: In our experience patients with major preoperative airway obstruction who underwent pneumonectomy had lower impairment in FEV1% at almost one year after surgery than those with normal respiratory function. The resection of a certain amount of non-functional parenchyma associated with the mediastinal shift, with an improvement of the chest cavity for the remaining lung, could give a reduction volume effect in BPCO/emphysematous patients.

Key Words: Pneumonectomy • Lung cancer • Lung resection • BPCO • Pulmonary function test • Lung diffusion capacity