Effects of lung resection on pulmonary function and exercise capacity.

Pelletier, Chelsea; Lapointe, Luc; Leblanc, Pierre

doi:10.1136/thx.45.7.497

Cited by 96 publications

(70 citation statements)

References 18 publications

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“…PELLETIER et al [14] found a loss in exercise capacity of 28% after pneumonectomy and 20% after lobectomy. These results are difficult to compare to ours because of their early time-point of evaluation (mean 73 days after lobectomy and 62 days after pneumonectomy) and the wide range over which it took place (26-200 days).…”

Section: Discussionmentioning

confidence: 99%

“…Various previous reports have analysed functional loss in PFT after lung resection. Unfortunately, the time-points of analysis were quite different in some reports, making direct comparison difficult [11,14]. We decided on 3 and 6 months evaluation postoperatively for the following reasons.…”

Section: Discussionmentioning

confidence: 99%

“…An important complementary parameter for the assessment of the patient's functional status is his exercise capacity, which has been analysed less often [11][12][13][14] and does not necessarily correlate with the PFT [14]. We have recently reported on the importance of exercise capacity in the preoperative functional evaluation for the prediction of the immediate postoperative outcome in a series of 80 consecutive lung resection candidates [15].…”

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confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Pulmonary function and exercise capacity after lung resection

Bolliger¹,

Jordan²,

Solèr³

et al. 1996

Eur Respir J

196

131

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“…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]. As early as 1965, DEGRAFF et al [70] reported on exercise limitation after extensive pulmonary resection.…”

Section: Effect Of Lung Resection On Postoperative Pulmonary Functionmentioning

confidence: 99%

“…PELLETIER et al [149] investigated 20 patients after pneumonectomy and 27 after lobectomy. The mean decrease in FEV1 was 17% after lobectomy and 31% after pneumonectomy, and the respective values for the maximal work capacity were 12 and 26%.…”

Section: Diagnosismentioning

confidence: 99%

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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Safety and feasibility of aerobic training on cardiopulmonary function and quality of life in postsurgical nonsmall cell lung cancer patients

Jones

Eves

Peterson

et al. 2008

Cancer

139

161

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BACKGROUND. A feasibility study examining the effects of supervised aerobic exercise training on cardiopulmonary and quality of life (QOL) endpoints among postsurgical nonsmall cell lung cancer (NSCLC) patients was conducted. METHODS. Using a single‐group design, 20 patients with stage I‐IIIB NSCLC performed 3 aerobic cycle ergometry sessions per week at 60% to 100% of peak workload for 14 weeks. Peak oxygen consumption (VO2peak) was assessed using an incremental exercise test. QOL and fatigue were assessed using the Functional Assessment of Cancer Therapy–Lung (FACT‐L) scale. RESULTS. Nineteen patients completed the study. Intention‐to‐treat analysis indicated that VO2peak increased 1.1 mL/kg−1/min−1 (95% confidence interval [CI], −0.3‐2.5; P = .109) and peak workload increased 9 W (95% CI, 3‐14; P = .003), whereas FACT‐L increased 10 points (95% CI, −1‐22; P = .071) and fatigue decreased 7 points (95% CI; −1 to −17; P = .029) from baseline to postintervention. Per protocol analyses indicated greater improvements in cardiopulmonary and QOL endpoints among patients not receiving adjuvant chemotherapy. CONCLUSIONS. This pilot study provided proof of principle that supervised aerobic training is safe and feasible for postsurgical NSCLC patients. Aerobic exercise training is also associated with significant improvements in QOL and select cardiopulmonary endpoints, particularly among patients not receiving chemotherapy. Larger randomized trials are warranted. Cancer 2008. © 2008 American Cancer Society.

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Effects of lung resection on pulmonary function and exercise capacity.

Cited by 96 publications

References 18 publications

Pulmonary function and exercise capacity after lung resection

Pulmonary function and exercise capacity after lung resection

Functional evaluation of the lung resection candidate

Safety and feasibility of aerobic training on cardiopulmonary function and quality of life in postsurgical nonsmall cell lung cancer patients

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