Influence of chronic obstructive pulmonary disease on postoperative lung function and complications in patients undergoing operations for primary non-small cell lung cancer.

OBJECTIVES: Recent data have suggested that there is a flexibility of borderline values of lung function tests in allowing safe lung resection. The aim of this study was to assess the pattern of postoperative lung function change in patients with chronic obstructive pulmonary disease compared with that of patients with normal lung function, and to compare the operative morbidity and mortality between these groups. METHODS: The study included 35 patients with chronic obstructive pulmonary disease and a control group of 47 patients with normal lung function who underwent lung resection for non-small cell lung cancer. The percent changes of lung function parameters after lung resection and operative morbidity and mortality were compared between groups. RESULTS: The mean postoperative loss in forced expiratory volume in the 1st second was significantly less in patients with chronic obstructive pulmonary disease who underwent lobectomy compared with that of patients with normal lung function (11.88% vs 24.6%, P < .05); forced expiratory flows at low lung volumes (50% and 25%) improved in patients who underwent lobectomy. The lung function change after pneumonectomy followed the same trend as that after lobectomy. In patients with chronic obstructive pulmonary disease, forced expiratory volume in the 1st second and small airways function significantly improved after preoperative bronchodilator therapy. In the group with chronic obstructive pulmonary disease, operative mortality was 0 and operative morbidity was 51.43%. CONCLUSIONS: Because the pattern of lung function change is different in patients with chronic obstructive pulmonary disease compared with that of patients with normal lung function, surgery can be offered to carefully selected patients with lung cancer, even in the presence of severely limited lung function.

[Surgical treatment of patients with lung cancer and limited lung function--preoperative assessment, operative mortality and morbidity].

INTRODUCTION: Lung resection in patients with limited lung function is one of the greatest challenges in general thoracic surgery. OBJECTIVE: The aim of the study was to analyse the pattern of lung function changes after operation, operative morbidity and mortality and to compare them with control group of patients. METHOD: The study included 34 patients with limited lung function, operated for primary lung cancer in one-year period. All patients underwent preoperative desobstructive treatment. The type of ventilatory disorder was analysed depending on preoperative radiographic and bronchoscopic aspect. STATISTICS: chi-square test, t-test. RESULTS: In patients with lobectomy, the mean difference in forced expiratory volume in the first second (FEV1) between preoperative and postoperative values was 16.81%, whilst in the pneumonectomy group this difference was 39.51%. The mean change in forced vital capacity (FVC) in the lobectomy and pneumonectomy group was 15.83% and 42.73% respectively. In the control group of 28 patients with lobectomy, the decrease in FVC and FEV1 was 19.9% and 24.18% respectively. In the control group of 28 patients with pneumonectomy, the decrease in FVC and FEV1 was 43.52% and 41.36% respectively. In patients with limited lung function and lobectomy, changes in FEV1 and VC after resection were significantly lower compared to the control group of patients with lobectomy and normal lung function. None of 34 operated patients with borderline lung function died inside 30 postoperative days. In the same period, of a total number of 344 patients without respiratory function impairement, operative mortality was 3.1%. In the analysed group, operative morbidity was 32.35%. Cardiovascular and respiratory complications in the analysed and control groups occurred in 14.7% and 6.1% of patients respectively (p > 0.05). CONCLUSION: Surgery should not be excluded in patients with borderline lung function prior to preoperative treatment and additional lung function assessment.

[Pneumonectomy in bronchial carcinoma after prior pleural empyema]. / Pneumonektomija zbog karcinoma bronha posle empijema pleure.

Pneumonectomy is a lung resection that is associated with significantly higher operative mortality and morbidity than lobectomy. Beside classical causes of operative morbidity, such as respiratory and cardiovascular, the most important cause of postoperative complications is bronchopleural fistula. This complication occurs in 5 to 10 percents of patients with pneumonectomy, in some series up to 15 percents before introducing mechanical bronchial suture. The risk of the occurrence of this complication is increased in patients undergoing pneumonectomy after previous infection in the pleural space. Not so frequently, surgeons are faced with the necessity of performing pneumonectomy after pleural empyema as the first manifestation of the bronchus carcinoma. Over the last 5 years, in the the Institute of Lung Diseases, 4 patients underwent pneumonectomy after pleural empyema. The preoperative assessment, operative procedure and postoperative problems are the subject of this paper. Unlike the last three patients, in the first patient, pleural empyema was not recognized preoperatively. Based on the outcome of the treatment of the presented patients, we can conclude that pleural empyema, as the first manifestation of the bronchus carcinoma, does not necessarily exclude surgical treatment. Such a statement is based on the fact that, even in these patients, it is possible to achieve postoperative course without significant morbidity and with a possibility to perform various forms of adjuvant therapy.