Assessment of pulmonary function and quality of life in patients submitted to pulmonary resection for cancer.

OBJECTIVE: To evaluate the effects that pulmonary resection has on pulmonary function and quality of life (QoL) in patients with primary or metastatic lung cancer. METHODS: This was a prospective cohort study involving all patients submitted to pulmonary resection for cancer between September of 2006 and March of 2007 at the A. C. Camargo Hospital in São Paulo, Brazil. Patients underwent spirometry in the preoperative period and at six months after the surgical procedure. After a postoperative period of six months, the patients completed an overall QoL questionnaire (the Medical Outcomes Study 36-item Short-form Health Survey) and another one, specific for respiratory symptoms (the Saint George's Respiratory Questionnaire). The scores obtained in our study were compared with those previously obtained for a general population and for a population of patients with COPD. RESULTS: We included 33 patients (14 males and 19 females), ranging in age from 39 to 79 years. All of the patients, smokers and nonsmokers alike, presented significant worsening of pulmonary function. The mean scores on the overall QoL questionnaire were approximately 5% lower than those obtained for the general population. The scores of various domains of the symptom-specific QoL questionnaire were 50-60% lower than those obtained for the general population and approximately 20% higher than those obtained for the population with COPD. CONCLUSIONS: Pulmonary resection has a direct negative impact on pulmonary function and QoL, especially on the QoL related to aspects directly linked to pulmonary function. We highlight the importance of preoperative assessment of pulmonary function in patients undergoing pulmonary resection, in order to predict their postoperative evolution.

Avaliação da função pulmonar e da qualidade de vida em pacientes submetidos à ressecção pulmonar por neoplasia / Assessment of pulmonary function and quality of life in patients submitted to pulmonary resection for cancer

OBJETIVO: Avaliar as repercussões da ressecção pulmonar sobre a função pulmonar e a qualidade de vida (QV) de pacientes com câncer de pulmão primário ou metastático. MÉTODOS: Estudo de coorte prospectivo que incluiu todos os pacientes que realizaram ressecção pulmonar por neoplasia no Hospital A. C. Camargo entre setembro de 2006 e março de 2007. Os pacientes foram avaliados no pré-operatório e após seis meses do procedimento cirúrgico através de espirometria. Após seis meses de pós-operatório, os pacientes responderam a um questionário de QV geral (Medical Outcomes Study 36-item Short-form Health Survey) e um específico para sintomas respiratórios (Saint George's Respiratory Questionnaire). Os valores de QV obtidos foram comparados a valores de uma população geral e aos de uma população de portadores de DPOC. RESULTADOS: Foram incluídos 33 pacientes (14 homens e 19 mulheres), com idade entre 39 e 79 anos. Todos os pacientes, tabagistas ou não, apresentaram piora significativa da função pulmonar. Observamos uma redução de aproximadamente 5 por cento na média dos escores do questionário de QV geral em comparação àquela da população geral. Houve uma redução de 50-60 por cento nos vários domínios do questionário específico para sintomas, quando comparado aos resultados da população geral, e um aumento de aproximadamente 20 por cento, quando comparado aos resultados da população com DPOC. CONCLUSÕES: Existe impacto direto da ressecção pulmonar na deterioração da função pulmonar e na QV com ênfase nos aspectos diretamente ligados à função pulmonar. Cabe ressaltar a importância da avaliação da função pulmonar destes pacientes no pré-operatório para se estimar sua evolução pós-cirúrgica.

OBJECTIVE: To evaluate the effects that pulmonary resection has on pulmonary function and quality of life (QoL) in patients with primary or metastatic lung cancer. METHODS: This was a prospective cohort study involving all patients submitted to pulmonary resection for cancer between September of 2006 and March of 2007 at the A. C. Camargo Hospital in São Paulo, Brazil. Patients underwent spirometry in the preoperative period and at six months after the surgical procedure. After a postoperative period of six months, the patients completed an overall QoL questionnaire (the Medical Outcomes Study 36-item Short-form Health Survey) and another one, specific for respiratory symptoms (the Saint George's Respiratory Questionnaire). The scores obtained in our study were compared with those previously obtained for a general population and for a population of patients with COPD. RESULTS: We included 33 patients (14 males and 19 females), ranging in age from 39 to 79 years. All of the patients, smokers and nonsmokers alike, presented significant worsening of pulmonary function. The mean scores on the overall QoL questionnaire were approximately 5 percent lower than those obtained for the general population. The scores of various domains of the symptom-specific QoL questionnaire were 50-60 percent lower than those obtained for the general population and approximately 20 percent higher than those obtained for the population with COPD. CONCLUSIONS: Pulmonary resection has a direct negative impact on pulmonary function and QoL, especially on the QoL related to aspects directly linked to pulmonary function. We highlight the importance of preoperative assessment of pulmonary function in patients undergoing pulmonary resection, in order to predict their postoperative evolution.

Do concomitant ascites influence the effectiveness of palliative surgical management of pleural effusion in patients with malignancies?

BACKGROUND: Both pleural and peritoneal effusions are associated with dismal prognosis for patients with malignancies. Pleural effusion often requires surgical palliative management to relieve symptoms. The aim of this study was assess the influence of concomitancy of ascites on the success rate of surgical management of pleural effusion in patients with solid malignancies. METHODS: We retrospectively identified 33 patients with different primary malignancies, who underwent palliative surgical treatment for pleural effusion with concomitant ascites. The success rate of pleural effusion management was compared to that of a control group of patients with pleural effusion without ascites. RESULTS: Ovarian and breast cancer were the most common primary sites in the group of patients with pleural and peritoneal effusions. Thoracocentesis was performed in 30 patients with concomitant ascites and in 29 patients without ascites. The median number of thoracocentesis procedures was two in both groups of patients. Talc pleurodesis was performed in 57.6 and 63.3% of patients with and without ascites, respectively. The success rate of pleurodesis was 68.4 and 71.9% for patients with and without concomitant ascites (P = 0.92), respectively. There was no significant difference in the median length of time of the chest tube placement between the two groups (with ascites, 6 days; without ascites, 5 days, P = 0.38). The overall survival was 5.6 months for patients with ascites and 7.8 months for patients without ascites (P = 0.51). CONCLUSION: Our results suggest that concomitant ascites did not influence the effectiveness of palliative surgical management of pleural effusion in patients with malignancies.