Prospective evaluation for pneumonectomy using perfusion scanning: follow-up beyond one year

Area of Science:

• Thoracic Surgery
• Pulmonary Medicine
• Oncology

Background:

• Lung cancer surgery, particularly pneumonectomy, poses significant risks for patients with compromised pulmonary function.
• Accurate preoperative assessment is crucial for determining operability and optimizing patient outcomes.

Purpose of the Study:

• To evaluate the efficacy of a simplified physiologic assessment for selecting high-risk patients undergoing pneumonectomy for lung cancer.
• To determine the long-term survival rates in this patient cohort.

Main Methods:

• Thirty-eight high-risk patients (FEV1 < 2.0L or MVV < 50% predicted) were assessed.
• Operability was determined by a predicted postoperative forced expiratory volume in one second (FEV1) exceeding 800 ml, estimated via lung perfusion scans.
• No other invasive physiologic tests were used preoperatively.

Main Results:

• At one year post-pneumonectomy, 23 out of 38 patients survived.
• By the second year, 13 out of 38 patients were still alive.
• At five years, two out of 15 patients survived with no evidence of metastatic disease.

Conclusions:

• A straightforward physiologic approach using predicted postoperative FEV1 and lung perfusion scans is effective for selecting high-risk lung cancer patients for pneumonectomy.
• This method utilizes widely available techniques and appears to yield acceptable long-term survival rates.