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| Respiratory Function After Pneumonectomy. Results of the Pneumonectomy Project |
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Jean Deslauriers, Steeve Provencher, Paula Ugalde, Santiago Miro, Yves Lacasse, Sébastien Bergeron, Sylvie Ferland Centre de pneumologie, IUCPQ (Hôpital Laval), Quebec, QC, Canada Objective: Although more than 75 years have elapsed since the first successful one-stage pneumonectomy for lung cancer, little information is available regarding long-term changes in pulmonary function in such individuals. The objectives of this study were to analyse these changes so that surgical myths dating back to the early days of thoracic surgery could be revisited. Methods: Among 523 consecutive patients who underwent pneumonectomy for lung cancer between 01-92 and 09-01, 117 were alive at the time of study (2006) and thus had 5 years minimum follow-up. Of these, 17 were excluded, leaving 100 individuals available for study (mean follow-up time of 9.1 ± 2.8 years). Over one day, each patient underwent complete medical history, standard chest radiographs, thoracic MRI, pulmonary function studies, arterial blood gas analysis, a 6-minute walk test, and cardiac ultrasonography . Each also completed the ATS respiratory questionnaire form. Results: In comparison with pre-operative values, the functional percentage losses in expiratory lung volumes were 38 ± 19 % for FEV1, 31 ± 24 % for FVC and 33 ± 18 % for DLCO. There was a significant correlation between pre and post-operative FEV1 (p < 0.001) although there was a wide range of variation between individuals (R = 0.47). In a multivariate linear regression analysis, normal ipsilateral diaphragmatic motion, higher pre-operative FEV1, more hyperinflation of the remaining lung, female gender and younger age were significant factors for better post-operative FEV1 (p < 0.01). Gas exchange at rest was normal (Pa02 = 88 ± 10 mm Hg; PaCO2 : 42 ± 3 mm Hg), and exercise tolerance as assessed by the 6-minute walk test was also normal (83 ± 17 % of predicted values). Most patients (73 %) had no or only minimal dyspnea (ATS grade 0-2). Twenty eight patients (36 %) with measurable ultrasonographic PAP had pulmonary hypertension but in most it was mild to moderate (mean of 37 ± 8) and not associated with significant differences in lung function (p = 0,34 for FEV1), gas exchange (p = 0.01) and exercise tolerance (p = 0.99). Conclusion: These findings are important because they show that despite a worsening of lung function by 30-35 %, gas exchange at rest and exercise tolerance remain normal after pneumonectomy. Most importantly, hyperinflation of the remaining lung is not detrimental to residual lung function. Pulmonary hypertension is uncommon and in most cases it is only mild to moderate. Back to 2010 Annual Meeting Back to Program Outline Back to Main Program |
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Copyright © 2012 American Association for Thoracic Surgery
All rights reserved. IMPORTANT REMINDER: The preceding information is intended only to provide
general guidance and not as a definitive basis for diagnosis or treatment in any particular case.
It is very important that you consult a doctor about any specific medical problem or question.
All rights reserved. IMPORTANT REMINDER: The preceding information is intended only to provide
general guidance and not as a definitive basis for diagnosis or treatment in any particular case.
It is very important that you consult a doctor about any specific medical problem or question.