Unilateral lung volume reduction in preparation for contralateral pneumonectomy

Area of Science:

• Thoracic Surgery
• Pulmonary Medicine
• Surgical Oncology

Background:

• Locally advanced lung malignancies often present complex surgical challenges, particularly in patients with underlying chronic obstructive pulmonary disease (COPD).
• Pre-operative assessment of pulmonary function is critical for determining surgical candidacy and optimizing outcomes in lung cancer patients with emphysema.
• Lung volume reduction (LVR) surgery is a therapeutic option for severe emphysema, aiming to improve respiratory mechanics and functional capacity.

Observation:

• A 50-year-old male with a history of bullous emphysema and poor pulmonary function was diagnosed with locally advanced left lung malignancy.
• The patient underwent a staged surgical procedure involving right unilateral lung volume reduction (LVR) followed by left pneumonectomy six weeks later.
• Pulmonary function tests showed an improvement in forced expiratory volume in 1 second (FEV1) from 1.37 L (47% predicted) to 1.85 L five weeks post-LVR.

Findings:

• The staged approach, incorporating LVR prior to pneumonectomy, was successfully completed.
• Post-LVR, the patient demonstrated improved FEV1, indicating enhanced pulmonary function.
• One year after discharge, the patient remained disease-free, active, and independent of oxygen support, with an FEV1 of 0.9 L.

Implications:

• Staged LVR followed by pneumonectomy can be a viable strategy for managing lung cancer in patients with severe emphysema.
• This approach may improve functional outcomes and facilitate radical treatment in selected patients.
• Optimizing pulmonary reserve through LVR can potentially enhance recovery and long-term quality of life after major lung resection.