Predicting Loss of Pulmonary Function After Pulmonary Resection for Bronchogenic Carcinoma

Ali, Mohsin; Mountain, Clifton F.; Ewer, Michael S.; Johnston, Dennis A.; Haynie, Thomas P.

doi:10.1378/chest.77.3.337

Cited by 193 publications

(67 citation statements)

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“…We chose 3 months as the "early" time-point for evaluation beyond which further functional recovery is to be expected. This also allowed direct comparison with other reports, such as those by OLSEN et al [4] and by ALI et al [7] for the 3 month evaluation; or those by LODDENKEMPER et al [10] and by VAN MIEGHEM et al [13] for the 6 month evaluation. The second time-point at 6 months was chosen to evaluate the permanent functional loss.…”

Section: Discussionmentioning

confidence: 83%

“…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%

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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: 83%

mentioning

confidence: 99%

Pulmonary function and exercise capacity after lung resection

Bolliger¹,

Jordan²,

Solèr³

et al. 1996

Eur Respir J

196

131

View full text Add to dashboard Cite

show abstract

“…In the early 1970s, KRISTERSSON et al [44] were able to accurately predict the functional loss after pneumonectomy and lobectomy [113]. TØNNESEN et al [114] and subsequently ALI et al [115] have confirmed these findings, the latter as long as the resection involved more than three segments. Since then, radiospirometry has been replaced by split perfusion scans using intravenous technetium-99 macroaggregate.…”

Section: Split-function Studiesmentioning

confidence: 97%

“…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%

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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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Preoperative Pulmonary Evaluation

Jackson¹

1988

Arch Intern Med

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Predicting Loss of Pulmonary Function After Pulmonary Resection for Bronchogenic Carcinoma

Cited by 193 publications

References 14 publications

Pulmonary function and exercise capacity after lung resection

Pulmonary function and exercise capacity after lung resection

Functional evaluation of the lung resection candidate

Preoperative Pulmonary Evaluation

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