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J Thorac Cardiovasc Surg 2007;134:1292-1299
© 2007 The American Association for Thoracic Surgery

General Thoracic Surgery

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

Dragan R. Subotic, MD, PhDa,*, Dragan V. Mandaric, MD, PhDa, Tatjana M. Eminovic, MDa, Milan M. Gajic, MSb, Natasa M. Mujovic, MDa, Nikola D. Atanasijadis, MDa, Predrag P. Dzeletovic, MDa, Ljiljana D. Andric, MDa, Branka M. Bulajic, MDa, Ivan D. Dimitrijevic, MD, PhDa, Dragana P. Sobic, MD, PhDc

a Institute for Lung Diseases, Clinical Center of Serbia, Belgrade, Serbia
c Institute for Nuclear Medicine, Clinical Center of Serbia, Belgrade, Serbia
b Institute for Medical Statistics, Faculty of Medicine, Belgrade, Serbia.

Received for publication February 28, 2007; revisions received July 20, 2007; accepted for publication July 26, 2007.

* Address for reprints: Dragan Subotic, MD, PhD, Institute for Lung Diseases, Clinical Center of Serbia, 11000 Belgrade, Serbia. (Email: vilusi{at}yubc.net).

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.

Abbreviations and Acronyms COPD = chronic obstructive pulmonary disease; DLCO = carbon monoxide diffusion capacity in the lung; FEF = forced expiratory flow; FEV1 = forced expiratory volume in the 1st second; VC = vital capacity




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