Short- and Mid-Term Changes in Lung Function after Bilateral Pulmonary Metastasectomy

Area of Science:

• Thoracic Surgery
• Pulmonary Medicine
• Oncology

Background:

• Pulmonary metastases resection can lead to significant lung function loss.
• The extent of functional impairment after bilateral metastasectomy is not well-defined.
• Preserving pulmonary function is crucial for quality of life in long-term survivors.

Purpose of the Study:

• To quantify pulmonary function loss following bilateral pulmonary metastasectomy.
• To compare functional outcomes between bilateral and unilateral metastasectomy.
• To assess the impact of staged resections on lung function.

Main Methods:

• Post-hoc subanalysis of 31 patients undergoing bilateral pulmonary metastasectomy.
• Pulmonary function tests (PFTs), including spirometry, diffusing capacity of lung for carbon monoxide (Dlco), and blood gases, were performed preoperatively and at 3-month follow-up.
• Comparison with a cohort of 86 patients who underwent unilateral metastasectomy.

Main Results:

• Mean pulmonary function loss at follow-up: forced vital capacity (FVC) -15.2%, total lung capacity (TLC) -13.8%, forced expiratory volume in 1 second (FEV1) -16.3%, and Dlco -10.3% (all significant, p < 0.001).
• Patients with staged PFTs showed a stepwise decline, with values around -40% after the second surgery, accompanied by a significant reduction in Po2.
• Bilateral metastasectomy involved significantly more nodules (8.2 vs. 3.1) and resulted in approximately double the loss of volume parameters compared to unilateral surgery.

Conclusions:

• Midterm pulmonary function impairment after bilateral pulmonary metastasectomy is substantial, affecting spirometry and Dlco.
• The functional deficit is nearly double that observed after unilateral surgery.
• Bilateral metastasectomy should be considered cautiously in patients with pre-existing pulmonary limitations due to significant functional loss.