Steven R. DeMeester, MD. , G. Alexander Patterson, MD, R

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Presentation transcript:

Lobectomy Combined With Volume Reduction For Patients With Lung Cancer And Advanced Emphysema Steven R. DeMeester, MD*, G.Alexander Patterson, MD, R.Sudhir Sundaresan, MD, Joel D. Cooper, MD The Journal of Thoracic and Cardiovascular Surgery Volume 115, Issue 3, Pages 681-688 (March 1998) DOI: 10.1016/S0022-5223(98)70334-4 Copyright © 1998 Mosby, Inc. Terms and Conditions

Figure 1 A, Posteroanterior chest x-ray film of patient a showing characteristics of severe emphysema including bilateral pulmonary hyperinflation and flattened diaphragms. The right upper lobe nodule is faintly visible. B, Posterior view of the ventilation portion of a ventilation-perfusion scan from the same patient. The left lung has greater overall ventilation, and there is bilateral upper lobe destruction, particularly on the right. The Journal of Thoracic and Cardiovascular Surgery 1998 115, 681-688DOI: (10.1016/S0022-5223(98)70334-4) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 2 Distance walked in 6 minutes in each of the four patients who underwent preoperative pulmonary rehabilitation. The greatest gains were demonstrated in the patients most deconditioned at the time of evaluation (patients c and d). The best-conditioned patients at the time of evaluation (patients a and e) did not improve with preoperative structured pulmonary rehabilitation and showed early postoperative decline in 6-minute walk distance. The Journal of Thoracic and Cardiovascular Surgery 1998 115, 681-688DOI: (10.1016/S0022-5223(98)70334-4) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 3 FEV1 values improved in each patient after lobectomy and volume reduction when compared with the postrehabilitation, preoperative value. The improvements have persisted for 2 years in one patient and for 1 year in two patients. Peak postoperative improvement seems to occur during the first 6 months and is followed by a slow decline toward the preoperative value (see discussion). Importantly, note that the postoperative FEV1 value was not decreased after lobectomy and volume reduction in any of the five selected patients with advanced emphysema and lung cancer. The Journal of Thoracic and Cardiovascular Surgery 1998 115, 681-688DOI: (10.1016/S0022-5223(98)70334-4) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 4 Both total lung capacity (TLC, shown in bold lines) and residual volume (RV, shown in light lines) decreased after lobectomy and volume reduction in selected patients with advanced emphysema and lung cancer. The Journal of Thoracic and Cardiovascular Surgery 1998 115, 681-688DOI: (10.1016/S0022-5223(98)70334-4) Copyright © 1998 Mosby, Inc. Terms and Conditions