Pulmonary Function Changes Over 1 Year After Lobectomy in Lung Cancer

Abstract

BACKGROUND: This study was conducted to measure the serial changes in pulmonary function over 12 months after lobectomy in subjects with lung cancer and to evaluate the actual recovery of pulmonary function in comparison with the predicted postoperative values. METHODS: Subjects who underwent lobectomy for primary lung cancer were included in this study. In the statistical analysis, we included data from 76 subjects (52 men and 24 women; mean age, 63.4 y) who completed perfusion scintigraphy 1 week before surgery and FEV 1 and diffusion capacity of the lung for carbon monoxide (D LCO ) assessments preoperatively and at 1, 6, and 12 months postoperatively. RESULTS: The actual percent-of-predicted FEV 1 1 month postoperatively was 77.9% of the preoperative value, which was almost equal to the predicted postoperative value, and significantly increased to 84.3% by 6 months and 84.2% at 12 months. The actual percent-of-predicted D LCO 1 month postoperatively was 81.8% of the preoperative value, which was similar to the predicted postoperative value, and also significantly increased to 91.3% at 6 months and 96.5% at 12 months. However, the actual pulmonary function test results at 1 y in subjects with COPD or in those who underwent thoracotomy or received adjuvant chemotherapy were not different from the predicted postoperative values. CONCLUSIONS: Actual pulmonary function compared with predicted postoperative values improved over time over 1 y after lobectomy. However, this improvement was not observed in subjects with COPD or in those who underwent thoracotomy or received postoperative adjuvant chemotherapy.

Physical Activity and Exercise in Lung Cancer Care: Will Promises Be Fulfilled?

“…After 8 weeks of training, an increase was observed in exercise capacity (the primary outcome), without any significant improvement in other parameters, such as strength, QoL, fatigue, anxiety, depression, and pulmonary function [43]. However, in the first year after surgery, patients usually experience an increase in pulmonary parameters [68] that may be attributed to compensatory mechanisms, such as the expansion of the remaining lobes and vascular tissues [69]. In this postoperative context, studies testing different training programs are consistent in detecting an improvement in respiratory muscle strength and/or functionality [42, 52,70].…”

Characterization of Dyspnea in Lung Cancer Survivors Following Curative-Intent Therapy

“…The mechanisms of dyspnea are incompletely understood [34]; however, peripheral sensors including through reflex chemoreceptor stimulation by carbon dioxide, pulmonary vagal C-fibers, mechanoreceptors, and central pathways (specifically the limbic system and sensorimotor cortex) are thought to play important roles [34]. In lung cancer survivors following curative-intent therapy, dyspnea can be made worse due to a loss of 10-15% of lung function from lobectomy [35]. Additionally, other possible pathophysiological effects may include a loss of associated nerve fibers and peripheral sensors due to the removal and/or destruction of lung tissue by surgery and/or radiotherapy.…”

Effects of Curative-Intent Lung Cancer Therapy on Functional Exercise Capacity and Patient-Reported Outcomes

“…Immediately following curative-intent therapy, lung cancer patients are at risk for worsening health due to the toxicities and side effects of treatment. Depending on the extent of resection, a loss of 10-15% of lung function [including forced expiratory volume in 1 second (FEV1) and diffusion capacity of the lung for carbon monoxide (DLCO)] is expected at 3-6 months [5,6] following lung cancer resection surgery and may persist at one year [7,8]. In addition, perioperative pulmonary [9] and cardiopulmonary [10] complications occur in 15% and 35% of patients, respectively, and can lead to negative health consequences beyond the perioperative period [11].…”