Impact on pulmonary function after lobectomy in patients with chronic obstructive pulmonary disease

The purpose of this study was to evaluate the operative outcome and pulmonary function after lobectomy; this included systematic mediastinal and hilar lymph node dissection for primary non-small cell lung cancer or pulmonary metastases of extrapulmonary origin in patients with chronic obstructive pulmonary disease (COPD) and a preoperative FEV (1) of less than 1.5 l (< 80 % of predicted value) and FEV (1)/FVC < 70 % (COPD II degrees ).

A retrospective analysis was undertaken in 79 patients who had consecutively undergone lobectomy with a preoperative FEV (1) < 1.5 l (< 80 %) and FEV (1)/FVC < 70 % (COPD II degrees ). Inclusion criteria were the ability to complete pulmonary function tests and lobectomy for malignancy. Patients with small cell lung cancer and unable to quit smoking less than 6 months prior to surgery were excluded. In 38 cases, pulmonary function tests were performed at 3 months after surgery, and 16 patients had tests at 3 and 6 months.

A total of 79 patients were included in this study, with a median age of 70 years (range: 45 - 85 years). The median preoperative FEV (1) was 1.3 l (range: 0.8 - 1.5 l), and patients underwent assisted ventilation for less than 1 hour after surgery (range: 0 - 214 h), and stayed for less than 24 h in the intensive care unit (range: 1 h-56 d). Three patients (3.8 %) died within 30 days after lobectomy. In 14 patients, additional treatment for surgical complications was performed (17.7 %). Follow-up after surgery revealed a significant decrease in FVC and FEV (1) (- 17 % and - 8 %, P < 0.005), but function had improved again (+ 10 % and + 11 %, P < 0.05) at 3 months after surgery and remained stable at 6 months after lobectomy. No statistically significant changes were noticed for paO (2) and paCO (2) values after surgical treatment.

It appears that surgical resection of malignant lung tumours by lobectomy can also be performed successfully in selected patients with low FEV (1) and COPD II degrees without significant loss of pulmonary function.