The effect of lung resection on pulmonary function and exercise capacity in lung cancer patients

Prospectively to evaluate the effects of lung resection on lung function (as measured via spirometry) and exercise capacity (as measured via shuttle-walk test) in lung cancer patients.

We conducted pulmonary function tests and the shuttle-walk test with 110 consecutive patients, before and 1 month, 3 months, and 6 months after lobectomy (n = 73) or pneumonectomy (n = 37). All the patients underwent a standard posterolateral thoracotomy. Eighty-eight patients completed all 3 postoperative assessments.

At 6 months after resection, the lobectomy patients had lost 15% of their preoperative forced expiratory volume in the first second (FEV1) (p < 0.001) and 16% of their exercise capacity (p < 0.001), and the pneumonectomy patients had lost 35% of their preoperative FEV(1) (p < 0.001) and 23% of their exercise capacity (p < 0.001).

Lobectomy patients suffered significant reduction of functional reserve, with almost equal deterioration between lung function and exercise capacity. Pneumonectomy patients had a more substantial loss of functional reserve, and a disproportionate loss of pulmonary function relative to exercise capacity. Therefore, pulmonary function test values considered in isolation may exaggerate the loss of functional exercise capacity in pneumonectomy patients, which is important because many lung cancer patients who require resection for cure are prepared to accept the risks of immediate surgical complications and mortality, but are unwilling to risk long-term poor exercise capacity.