Limited resection of bronchogenic carcinoma in the patient with impaired pulmonary function

Surgical resection is the treatment of choice for non-small cell carcinoma of the lung. In some patients with marked impairment of pulmonary function, cardiac disease, or other medical conditions, the surgeon is faced with performing either a limited resection or carrying out nonoperative therapy. Impaired pulmonary functions are defined as a maximum breathing capacity (MBC) of 35% to 40% of predicted; forced expiratory volume in 1 second (FEV1) of less than 1 L; and a forced expiratory volume 25%-75% (FEV25-75) of less than 0.6 L. When MBC values are less than 35% of predicted; the FEV1 is less than 0.6 L; and the FEV25-75 is less than 0.6 L, elective resection is contraindicated. Useful criteria for indicating an elective limited resection include the following: (1) T1 lesion, (2) peripheral location, (3) margins easily encompassed by resection, and (4) no gross lymph node involvement. In a study of 67 patients, there was 1 postoperative death, with less than an 80% 2-year survival and a 31% 5-year survival. The role of video-assisted thoracoscopy in the management of primary lung cancer remains to be defined. When the high-risk patient can be operated on with attendant low morbidity and mortality, I believe, at the current time, a video-assisted thoracic resection for primary lung cancer is not the best option, as the patient will be offered a compromised operation, and I suspect follow-up studies will prove this correct.