Criteria of Functional Operability in Patients with Bronchial Carcinoma : Preoperative Assessment of Risk and Prediction of Postoperative Function*

Loddenkemper, R.; Gabler, A; Göbel, D

doi:10.1055/s-2007-1022013

Cited by 37 publications

(22 citation statements)

References 3 publications

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“…According to GOERG et al [54] Ppa on moderate exercise should be <35 mmHg for a pneumonectomy and <40 mmHg for a lobectomy. LODDENKEMPER et al [16] did not find the Ppa on exercise predictive up to a value of 45 mmHg. OLSEN et al [73] found neither Ppa nor the calculated pulmonary vascular resistance (PVR) on submaximal exercise predictive of postoperative complications.…”

Section: Pulmonary Haemodynamicsmentioning

confidence: 99%

“…The answer depends mainly on the extent of resection. Various studies have looked at the functional loss after lung resection in terms of pulmonary function [16,44,113,[115][116][117][145][146][147]. ALI et al [115] and LODDENKEMPER et al [16] have shown that resections involving not more than one lobe lead to an early loss in pulmonary function with later recovery and little permanent deficit.…”

Section: Effect Of Lung Resection On Postoperative Pulmonary Functionmentioning

confidence: 99%

“…Various studies have looked at the functional loss after lung resection in terms of pulmonary function [16,44,113,[115][116][117][145][146][147]. ALI et al [115] and LODDENKEMPER et al [16] have shown that resections involving not more than one lobe lead to an early loss in pulmonary function with later recovery and little permanent deficit. As for the preoperative assessment, exercise capacity reflects the functional postoperative reserves better than simple PFT, but has been investigated much less frequently than PFT [70,124,148,149].…”

Section: Effect Of Lung Resection On Postoperative Pulmonary Functionmentioning

confidence: 99%

“…LODDENKEMPER et al [16] suggested clearly more conservative values of >2.5 L for a pneumonectomy, >1.75 L for lobectomy, and >1.5 L for segmentectomy. WERNLY et al [15] also suggested an FEV1 >2 L for pneumonectomy, with the rationale that with a 50% leftright functional distribution the postresectional FEV1 would be 1 L, which they deemed to be the lower limit for adequate pulmonary reserve.…”

Section: Spirometrymentioning

confidence: 99%

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Functional evaluation of the lung resection candidate

Bolliger¹,

Perruchoud²

1998

Eur Respir J

163

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Advances in operative technique and perioperative care have considerably reduced surgical morbidity and mortality after pulmonary resections. Various single and combined parameters of functional operability have been proposed to assess the surgical risk. Pulmonary function tests adequately assess the pulmonary risk, and baseline or stress electrocardiography, echocardiography and nuclear cardiac studies assess the cardiac risk.Patients with normal or only slightly impaired pulmonary function (forced expiratory volume in one second (FEV1) and transfer factor of the lung for carbon monoxide (TL,CO) ≥80% of predicted) and no cardiovascular risk factors can undergo pulmonary resections up to a pneumonectomy without further investigation. For others, exercise testing, pulmonary split-function studies, or a combination of these two methods are recommended. Exercise testing, most frequently performed as a symptom-limited test with the measurement of maximal oxygen uptake (V 'O 2 ,max), assesses both the pulmonary and cardiovascular reserves. A V'O 2 ,max of <10 mL·kg -1 ·min -1 is generally considered prohibitive for any resection, a value of >20 mL·kg -1 ·min -1 or >75% of predicted normal, safe for major resections. Split-function studies are radionuclide-based estimations of the predicted postoperative (ppo) values of various parameters. The currently used ppo-parameters are FEV1-ppo, TL,CO-ppo and, most recently, V'O 2 ,max-ppo. Suggested cutoff values for safe resection are: for FEV1-ppo and TL,CO-ppo ≥40% pred; and for V 'O 2 ,max ≥35% pred, combined with an absolute value of ≥10 mL·kg -1 ·min -1 . The lowest acceptable ppo-values will still have to be established by additional prospective studies.In the long-term, resections involving not more than one lobe usually lead to an early functional deficit followed by later recovery. The permanent functional loss in pulmonary function is small (≤10%) and exercise capacity is only slightly reduced or not at all. Pneumonectomy, on the other hand, leads to an early permanent loss of about 33% in pulmonary function and 20% in exercise capacity. Thus, pulmonary function tests alone overestimate the functional loss after lung resection. Eur Respir J 1998; 11: 198-212 The dramatic increase in the incidence of bronchogenic carcinoma has made this disease the most frequent malignancy worldwide. In industrialized nations, the majority of lung resection candidates suffer from bronchogenic carcinoma, whereas only some decades ago benign conditions, such as destroyed lung parenchyma after tuberculosis, had to be removed. The prognosis of bronchogenic carcinoma remains sombre as about 75-85% are inoperable at the time of diagnosis [1], and despite recent advances in chemo-and radiotherapy regimens, surgical resection remains the only curative form of treatment [2].Depending on their extent, pulmonary resections lead to permanent loss of pulmonary function. In healthy people, resections up to a pneumonectomy are tolerated remarkably well. Lung cancer patients, however, are...

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Section: Pulmonary Haemodynamicsmentioning

confidence: 99%

Section: Effect Of Lung Resection On Postoperative Pulmonary Functionmentioning

confidence: 99%

Section: Effect Of Lung Resection On Postoperative Pulmonary Functionmentioning

confidence: 99%

Section: Spirometrymentioning

confidence: 99%

See 2 more Smart Citations

Functional evaluation of the lung resection candidate

Bolliger¹,

Perruchoud²

1998

Eur Respir J

163

View full text Add to dashboard Cite

show abstract

“…Various studies have investigated the functional loss after lung resection in terms of pulmonary function tests (PFT) [2][3][4][5][6][7][8][9][10]. It is generally accepted that resections involving not more than one lobe lead to an early loss in PFT with later recovery and little permanent deficit, whereas pneumonectomies cause a bigger permanent functional loss [7,10].…”

mentioning

confidence: 99%

Pulmonary function and exercise capacity after lung resection

Bolliger¹,

Jordan²,

Solèr³

et al. 1996

Eur Respir J

196

131

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The influence of pulmonary resection on functional capacity can be assessed in different ways. The aim of this study was to compare the effect of lobectomy and pneumonectomy on pulmonary function tests (PFT), exercise capacity and perception of symptoms.Sixty eight patients underwent functional assessment with PFT and exercise testing before (Preop), and 3 and 6 months after lung resection. In 50 (36 males and 14 females; mean age 61 yrs) a lobectomy was performed and in 18 (13 males and 5 females; mean age 59 yrs) a pneumonectomy was performed.Three months after lobectomy, forced vital capacity (FVC), forced expiratory volume in one second (FEV1), total lung capacity (TLC), transfer factor of the lungs for carbon monoxide (TL,CO) and maximal oxygen uptake (V'O 2 ,max) were significantly lower than Preop values, increasing significantly from 3 to 6 months after resection. Three months after pneumonectomy, all parameters were significantly lower than Preop values and significantly lower than postlobectomy values and did not recover from 3 to 6 months after resection. At 6 months after resection significant deficits persisted in comparison with Preop: for FVC 7% and 36%, FEV1 9% and 34%, TLC 10% and 33% for lobectomy and pneumonectomy, respectively; and V'O 2 ,max 20% after pneumonectomy only. Exercise was limited by leg muscle fatigue in 53% of all patients at Preop. This was not altered by lobectomy, but there was a switch to dyspnoea as the limiting factor after pneumonectomy (61% of patients at 3 months and 50% at 6 months after resection). Furthermore, pneumonectomy compared to lobectomy led to a significantly smaller breathing reserve (mean±SD) (28±13 vs 37±16% at 3 months; and 24±11% vs 33±12% at 6 months post resection) and lower arterial oxygen tension at peak exercise 10.1±1.5 vs 11.5±1.6 kPa (76±11 vs 86±12 mmHg) at 3 months; 10.1±1.3 vs 11.3±1.6 kPa (76±10 vs 85±12 mmHg) at 6 months postresection.We conclude that measurements of conventional pulmonary function tests alone overestimate the decrease in functional capacity after lung resection. Exercise capacity after lobectomy is unchanged, whereas pneumonectomy leads to a 20% decrease, probably due to the reduced area of gas exchange.

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Comparison of relative forced expiratory volume of one second with dynamic magnetic resonance imaging parameters in healthy subjects and patients with lung cancer

Plathow

Fink

Sandner

et al. 2005

Magnetic Resonance Imaging

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Purpose: To assess relative forced expiratory volume in one second (FEV1/vital capacity (VC)) in healthy subjects and patients with a lung tumor using dynamic magnetic resonance imaging (dMRI) parameters. Materials and Methods:In 15 healthy volunteers and 31 patients with a non-small-cell lung carcinoma stage I (NSCLC I), diaphragmatic length change (LE1) and craniocaudal (CC) intrathoracic distance change within one second from maximal inspiration (DE1) were divided by total length change (LE total , DE total ) as a surrogate of spirometric FEV1/VC using a true fast imaging with steady-state precession (trueFISP) sequence (TE/TR ϭ 1.7/37.3 msec, temporal resolution ϭ 3 images/second). Influence of tumor localization was examined. Results:In healthy volunteers FEV1/VC showed a highly significant correlation with LE1/LE total and DE1/DE total (r Ͼ 0.9, P Ͻ 0.01). In stage IB tumor patients, comparing tumor-bearing with the non-tumor-bearing hemithorax, there was a significant difference in tumors of the middle (LE1/LE total ϭ 0.63 Ϯ 0.05 vs. 0.73 Ϯ 0.04, DE1/DE total ϭ 0.66 Ϯ 0.05 vs. 0.72 Ϯ 0.04; P Ͻ 0.05) and lower (P Ͻ 0.05) lung region. Stage IA tumor patients showed no significant differences with regard to healthy subjects.Conclusion: dMRI is a simple noninvasive method to locally determine LE1/LE total and DE1/DE total as a surrogate of FEV1/VC in volunteers and patients. Tumors of the middle and lower lung regions have a significant influence on these MRI parameters.

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Criteria of Functional Operability in Patients with Bronchial Carcinoma : Preoperative Assessment of Risk and Prediction of Postoperative Function*

Cited by 37 publications

References 3 publications

Functional evaluation of the lung resection candidate

Functional evaluation of the lung resection candidate

Pulmonary function and exercise capacity after lung resection

Comparison of relative forced expiratory volume of one second with dynamic magnetic resonance imaging parameters in healthy subjects and patients with lung cancer

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