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J Thorac Cardiovasc Surg 2005;130:1616-1622
© 2005 The American Association for Thoracic Surgery

General Thoracic Surgery

Does lobectomy for lung cancer in patients with chronic obstructive pulmonary disease affect lung function? A multicenter national study

^a Pulmonary Division
^b Division of Thoracic Surgery,University Hospital S. Giovanni Battista of Torino, Torino, Italy
^c Pulmonary Division
^d Department of Surgery, Division of General Surgery, University Hospital S. Giuseppe, Milano, Italy
^e Division of Thoracic Surgery, Policlinico IRCCS, University of Milano, Milano, Italy,
^f Department of Thoracic Surgery, Division of Thoracic Surgery, Policlinico Umberto I, University of Roma La Sapienza, Rome, Italy,
^g Department of Thoracic Surgery, Division of Thoracic Surgery,
^h Pulmonary Division, University Hospital of Padova, Padova, Italy
ⁱ Pulmonary Division
^j Division of Thoracic Surgery, Ospedale Ca' Foncello, Treviso, Italy
^k Division of Thoracic Surgery, Ospedale S. Raffaele IRCCS, Milan, Italy

Received for publication February 16, 2005; revisions received April 15, 2005; accepted for publication June 7, 2005.

^_* Address for reprints: Sergio Baldi, MD, Respiratory Diseases, Ospedale S. Giovanni Battista, 3 Via Genova, Torino 10126, Italy (Email: baldi_sergio{at}hotmail.com).

OBJECTIVE: The purpose of this study was to evaluate the effect of lobectomy on pulmonary function in patients with chronic obstructive pulmonary disease.

METHODS: One hundred thirty-seven patients were analyzed; 49 had normal pulmonary function tests, and 88 had chronic obstructive pulmonary disease. Different functional parameter groups were identified: obstructive (forced expiratory volume in 1 second [FEV₁], forced expiratory volume in 1 second/forced vital capacity [FEV₁/FVC], and chronic obstructive pulmonary disease index), hyperinflation (residual volume and functional residual capacity), and diffusion (transfer factor of the lung for carbon monoxide). Also, the ratio between observed and predicted postoperative FEV₁ was calculated.

RESULTS: In patients with preoperative FEV₁ greater than 80% of predicted, postoperative FEV₁/FVC slightly but not significantly decreased, and postoperative FEV₁ significantly decreased. In patients with preoperative FEV₁ less than 65%, postoperative FEV₁ and FEV₁/FVC significantly increased. In patients with preoperative FEV₁/FVC greater than 70%, postoperative FEV₁ and FEV₁/FVC significantly decreased. In patients with preoperative FEV₁/FVC less than 70%, postoperative FEV₁/FVC increased, and FEV₁ remained unchanged. In patients with a chronic obstructive pulmonary disease index greater than 1.5, postoperative FEV₁ and FEV₁/FVC significantly decreased, whereas in patients with a chronic obstructive pulmonary disease index less than 1.5, postoperative FEV₁/FVC significantly increased and FEV₁ remained unchanged. In patients with residual volume and functional residual capacity greater than 115% and transfer factor of the lung for carbon monoxide less than 80% of predicted, postoperative FEV₁ diminished less (not significant) compared with patients who had residual volume and functional residual capacity less than 115% (P = .0001). Observed postoperative/predicted postoperative FEV₁ was higher if FEV₁/FVC was less than 55% (1.46), if FEV₁ was less than 80% of predicted (1.21), or if the chronic obstructive pulmonary disease index was less than 1.5 (1.17).

CONCLUSIONS: Patients with mild to severe chronic obstructive pulmonary disease could have a better late preservation of pulmonary function after lobectomy than healthy patients.

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