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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

Sergio Baldi, MD a , * , Enrico Ruffini, MD b , Sergio Harari, MD c , Gian Carlo Roviaro, MD d , Mario Nosotti, MD e , Nadia Bellaviti, MD e , Federico Venuta, MD f , Daniele Diso, MD f , Federico Rea, MD g , Claudio Schiraldi, MD h , Alberto Durigato, MD i , Maurizio Pavanello, MD j , Angelo Carretta, MD k , Piero Zannini, MD k

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).


   Abstract
Top
 Abstract
Introduction
 Materials and Methods
 Results
 Discussion
 References
 
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.

Abbreviations and Acronyms COPD = chronic obstructive pulmonary disease; FEV1 = forced expiratory volume in 1 second; FEV1(%) = FEV1 percentage of predicted; FRC = functional residual capacity; FVC = forced vital capacity; PFT = pulmonary function test; RV = residual volume; TLCO = transfer factor of the lung for carbon monoxide


   Introduction
Top
 Abstract
 Introduction
Materials and Methods
 Results
 Discussion
 References
 
Lung cancer remains an important cause of death among smokers, and this condition is often associated with chronic obstructive pulmonary disease (COPD). Surgical resection offers the best chance for curing lung cancer, and lobectomy is the most frequent operation performed. Postoperative respiratory failure is a widely known complication that limits parenchymal resection in patients with COPD; exclusion criteria have been adopted to evaluate these patients, and most of them outline the importance of preoperative forced expiratory volume in 1 second (FEV1), FEV1/forced vital capacity (FVC), and transfer factor of the lung for carbon monoxide (TLCO). The 6-minute walking test, Master test, maximum oxygen consumption per unit time test, and prediction of postoperative FEV1 by different formulas are also used to evaluate postoperative risk. 1 Go More recently, lung volume reduction surgery and recent reports on COPD patients operated on for lung cancer have revised the lung function evaluation and predictors for COPD patients who are candidates for lung resection. 2-7 Go Unfortunately, most of these reports on lobectomy in patients with airway obstruction reviewed a limited number of cases, and the selection of operable patients remains a great challenge. 2-7 Go The goal of this study was to evaluate the effect of lobectomy on pulmonary function in COPD patients.


   Materials and Methods
Top
 Abstract
 Introduction
 Materials and Methods
Results
 Discussion
 References
 
This was a retrospective, multicenter national study. Data from 7 Italian hospitals with thoracic surgery experience (including lung transplantation, lung volume reduction surgery, or both) were collected. All patients with at least 1 preoperative and 1 postoperative pulmonary function evaluation who underwent lobectomy for lung cancer from March 1997 to March 2003 were considered; usually no more than a 6-month period was analyzed for each center. Postoperative pulmonary function tests (PFTs) were performed not earlier than the third postoperative month and not later than the 15th month. Patients who received any adjuvant or neoadjuvant therapy were not considered eligible for this study. One hundred thirty-seven patients met the criteria (35 women and 102 men); 49 had normal static and dynamic pulmonary function, according to European Respiratory Society 1993, whereas 88 had COPD ranging from grade 1 to 3 according to Global Initiative on Obstructive Lung Disease guidelines. Hyperinflation was considered if residual volume (RV) and functional residual capacity (FRC) were greater than 115% of predicted and vital capacity was in the normal limit, and impairment of gas transfer was defined as TLCO less than 80% of predicted. PFTs were performed in different laboratories by using the European Respiratory Society 1993 predicting values. All tests were performed with the same methods, and static volumes were measured by the nitrogen washout method. Patients were evaluated by radiograph and computed tomographic scan to stage the tumor, to ascertain the presence of a flattening diaphragm, and to distinguish bullous from nonbullous emphysema.

Ninety-two patients underwent upper lobectomy, 37 underwent lower lobectomy, and 8 underwent middle lobectomy; 17% of these patients had bullous emphysema, and 32% had diaphragmatic flattening. Thirty-one had squamous cell cancer, 72 had adenocarcinoma, 5 had small cell lung cancers, and 4 had carcinoid tumors. In 25 patients, histologic results were not available or were uncertain.

In all patients, the observed postoperative FEV1 was compared with the predicted postoperative FEV1 by the observed postoperative/predicted postoperative FEV1 ratio. The predicted postoperative FEV1 value was calculated with the following equation:


Formula

The COPD index was calculated according to Korst and associates 5 Go to evaluate the severity and purity of obstructive airway disease; the preoperative FEV1 (percentage of predicted in decimal form; FEV1%) was added to the preoperative ratio of FEV1 to FVC. Patients with the lowest COPD index are those with the most severe airway obstruction. Patients with a COPD index greater than 1.5 do not have obstructive diseases.

The mean age of COPD patients was 68 ± 15 years, and the mean age of non-COPD patients was 66 ± 13 years (mean ± SD). FEV1 ranged from 980 mL (34% of predicted) to 4050 mL (115% of predicted) in the entire study population. Preoperative functional data in healthy and COPD patients are shown in Table 1.


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  		TABLE 1. Study population
 
Statistical analysis included the paired t test for comparison of preoperative and postoperative mean values, because the patients were observed before and after a single treatment. Smith's statistical software package version 2.5, 2001 (by G. Smith, Claremont, Calif) was used for all analyses. Statistical methods included multiple comparisons of interrelated parameters, and this may cause problems with determining the appropriate significance level. To overcome this problem, we computed the number of comparisons for each category group (each table) and decreased the significance level by an appropriate factor accordingly. In particular, for 4 x 4 comparisons, the significance level was decreased by 20-fold (from .05 to .002), and for 4 x 2 comparisons, the significance level was decreased by 10-fold (from .05 to .005).


   Results
Top
 Abstract
 Introduction
 Materials and Methods
 Results
Discussion
 References
 
Flow volume and blood gas analyses were available in all patients, dynamic and static lung volumes were available in 108 patients, and carbon monoxide diffusion capacity was available in 89 patients. Preoperative chest radiographs and computed tomographic scans were examined in most COPD patients to consider diaphragmatic flattening and bullous emphysema. No postoperative differences were observed with regard to the lobectomy area because upper, lower, or middle lobe resection did not influence the postoperative FEV1 or FEV1/FVC change.

Patients were divided into different groups to characterize the grade of airway obstruction, the grade of hyperinflation, and the grade of carbon monoxide diffusion capacity. Changes of functional variables before and after operation were then analyzed.

Obstructive Parameters (FEV1[%], FEV1/FVC, and COPD Index)
We analyzed patients by considering 3 airway obstruction parameters: FEV1(%), FEV1/FVC, and COPD index. For FEV1(%), FEV1 group 1 included 65 patients with an FEV1 of 80% or more; FEV1 group 2 included 72 patients with FEV1 less than 80%; FEV1 subgroup 2a included 37 patients with FEV1 less than 65%; and FEV subgroup 2b included 35 patients with FEV1 between 65% and 79%. Among patients in FEV1 group 1, the postoperative FEV1/FVC slightly but not significantly decreased, whereas FEV1 significantly decreased and PaO 2 remained unchanged. In FEV1 group 2, FEV1/FVC significantly increased, and FEV1 and PaO 2 remained mostly unchanged. In FEV1 subgroup 2a, FEV1/FVC and FEV1 significantly increased, whereas in FEV1 subgroup 2b, both FEV1/FVC and FEV1 remained unchanged. RV significantly decreased on postoperative follow-up in all groups examined (Table 2). The observed postoperative/predicted postoperative ratio for FEV1 in FEV1 group 1 was lower (0.91 ± SD 0.1) than in FEV1 group 2a (1.21 ± SD 0.12) and FEV1 group 2b (1.22 ± SD 0.09; Figure 1).


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  		TABLE 2. FEV1 group data
 

Figure 1
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  		Figure 1. Observed postoperative/predicted postoperative FEV1 ratio according to FEV1(%).

 
For FEV1/FVC, FEV1/FVC group 1 included 49 patients with FEV1/FVC greater than 70%; FEV1/FVC group 2 included 88 patients with FEV1/FVC less than 70%; FEV1/FVC subgroup 2a included 29 patients with FEV1/FVC less than 55%; and FEV1/FVC subgroup 2b included 59 patients with FEV1/FVC between 55% and 69%. In FEV1/FVC group 1, FEV1 and FEV1/FVC significantly decreased, whereas PaO 2 remained unchanged; in FEV1/FVC group 2, FEV1 and PaO 2 remained mostly unchanged, whereas FEV1/FVC significantly increased. It is interesting to note that in FEV1/FVC subgroup 2a, FEV1 slightly increased (not significant) and FEV1/FVC significantly increased, but in FEV1/FVC subgroup 2b, FEV1 decreased and FEV1/FVC remained unchanged (Table 3 ). The observed postoperative/predicted postoperative ratio for FEV1 in FEV1/FVC subgroup 2a was significantly higher (1.46 ± SD 0.16) than in FEV1/FVC subgroup 2b (1 ± SD 0.09) and FEV1/FVC group 1 (0.95 ± SD 0.09; Figure 2).


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  		TABLE 3. FEV1/FVC group data
 

Figure 2
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  		Figure 2. Observed postoperative/predicted postoperative FEV1 ratio according to TI. TI, FEV1/FVC.

 
COPD index group 1 included 52 patients with an index greater than 1.5, and COPD index group 2 included 85 patients with an index less than 1.5. In COPD group 1, FEV1/FVC and FEV1 significantly decreased, whereas in COPD group 2, FEV1/FVC significantly increased, and FEV1 remained unchanged (Table 4). The observed postoperative/predicted postoperative ratio for FEV1 in group 2 (1.17 ± SD 0.06) was higher than in group 1 (0.91 ± SD 0.1; Figure 3).


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  		TABLE 4. COPD index group data
 

Figure 3
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  		Figure 3. Observed postoperative/predicted postoperative FEV1 ratio according to COPD index.

 
Hyperinflation Parameters (RV and FRC)
RV group 1 included 53 patients with RV greater than 115%, and RV group 2 included 55 patients with RV less than 115%. In RV group 1, FEV1 slightly (P = .06) decreased, and FEV1/FVC remained unchanged; in RV group 2, FEV1 significantly decreased, and FEV1/FVC remained unchanged (Table 5).


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  		TABLE 5. RV group data
 
FRC group 1 included 55 patients with FRC greater than 115%, and FRC group 2 included 53 patients with FRC less than 115%. In FRC group 1, FEV1 and FEV1/FVC remained statistically unchanged, whereas in FRC group 2, FEV1 decreased, and FEV1/FVC remained unchanged (Table 6).


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  		TABLE 6. FRC group data
 
Alveolar Diffusion Parameter (TLCO)
TLCO group 1 included 35 patients with a TLCO of 80% or more, and TLCO group 2 included 54 patients with a TLCO less than 80%. In TLCO group 1, FEV1 significantly decreased, whereas FEV1/FVC did not change; in TLCO group 2, FEV1 decreased, and FEV1/FVC increased, but these differences were not significant (Table 7).


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  		TABLE 7. TLCO group data
 

   Discussion
Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
References
 
Our results suggest that pulmonary function after lobectomy improves—or at least diminishes less—in COPD patients as compared with non-COPD patients and that this phenomenon is more evident in patients with more severe airway obstruction and hyperinflation. In particular, some of the preoperative functional parameters seem to be good predictors of late postoperative function improvement (or minimal change). FEV1/FVC improves if preoperative FEV1 is less than 65% of predicted, if preoperative FEV1/FVC is less than 55%, or if the COPD index is less than 1.5, whereas FEV1/FVC worsens if the preoperative FEV1/FVC is more than 70% and the COPD index is more than 1.5. FEV1 improves only if the preoperative FEV1 is less than 65%; it always worsens when airway flow indexes, diffusion capacity, and RV or FRC are in the normal range. Neither obstruction parameters (FEV1 and FEV1/FVC) nor diffusion capacity provides information on postoperative RV changes, because this index always worsens after operation and seems unrelated to these indexes. No change was observed before and after operation regarding oxygen exchange, and these data are unrelated to the preoperative functional data. It is interesting to note that the observed postoperative FEV1 is better than the predicted postoperative FEV1 if FEV1/FVC is less than 70%, if FEV1 is less than 80% of predicted, or if the COPD index is less than 1.5. TLCO and RV do not influence these variations. An important and practical consideration is that the predicted postoperative FEV1 underestimates the observed postoperative FEV1 by approximately 45% if the preoperative FEV1/FVC is less than 55% and by approximately 20% if the preoperative FEV1 is less than 80% of predicted.

Preoperative evaluation for lung resection in lung carcinoma has been well studied, and many reports have been published to evaluate the early and late operative risk for patients with obstructive airway diseases. 8-11 Go Advances in anesthesia and intensive care management can improve survival in some patients, but respiratory impairment in the long term remains a problem. Although many PFTs and exercise tests have been used to evaluate risk among these patients, obstructive indexes such as FEV1 and FEV1/FVC are still the most used criteria to exclude these patients from surgery. In general practice, a preoperative FEV1 less than 1.5 L or 60% of predicted or a predicted postoperative FEV1 less than 800 mL or 40% of predicted is considered a high risk for lobectomy. 1 Go Lung volume reduction surgery has demonstrated that lung function and dyspnea can improve after removal of portions of the lung parenchyma in patients with emphysema. Pulmonary nodule resection and lung volume reduction are feasible and are associated with minimal morbidity and significant improvement in pulmonary function. 12-17 Go

These data suggest that limited parenchymal resection, as well as lobectomy, might be beneficial for preserving lung function in patients with COPD. Previous investigators have demonstrated the feasibility of limited resection in patients with respiratory impairment. 18-21 Go Errett and colleagues 21 Go noted little difference in postoperative outcome in individuals with moderate airflow obstruction (mean FEV1 of 1.56 L); Miller and Hatcher 19 Go noted little perioperative difficulty in individuals with severe airflow obstruction (FEV1 less than 1.0 L) who underwent limited resection. More recently, it has been reported that pulmonary function might remain unchanged or even improve after lobectomy in COPD patients. 2-5 Go Korst and colleagues 5 Go reported that the mean change in FEV1 after lobectomy was +3.7% among patients with a preoperative FEV1 of less than or equal to 60% of predicted and was –15.7% for patients with a mean preoperative FEV1 of 69% of predicted. Sekine and associates 2 Go documented that the postoperative ventilatory function in COPD patients who had lower or middle/lower lobectomies was better preserved than predicted.

The most important consideration from our study, as well as from other similar studies, 2-5 Go is that some patients will have improved obstructive indexes after lobectomy: the increase of FEV1/FVC means that airway caliber or elastic recoil improves after resection. Our patients were identified retrospectively; therefore, we cannot know the precise nature of COPD and of the lung tissue resected (apart from the presence of bullae in a small group), but the consistent number of our sample implies that these results are not attributable to lung volume reduction surgery. Nevertheless, we can speculate that the mechanism of this airway improvement could be the relief of hyperinflation and/or chest wall mechanics, although this improvement should not be related to emphysematous lungs. Resection of a dead space in case of local pulmonary artery involvement could be another way to explain functional amelioration in some cases.

This study has several limitations. We analyzed only patients who had been discharged from the hospital, so we did not consider early postoperative mortality or early functional impairment. Furthermore, this was a retrospective study limited to the involvement of 7 different hospitals and selection of patients from different periods. Patients with available postoperative PFTs over a limited period (from the 3rd to 15th postoperative months) and in a consecutive temporal selection were involved. Patients first referred to the respiratory specialist always performed postoperative PFTs, but patients referred to a surgeon usually did not perform postoperative PFTs. Therefore, the selection criteria are related to the specialist who first visited the patient, and this was usually related to the practitioner who addressed the patient for further evaluation of a pulmonary lesion.

In conclusion, patients with mild to severe COPD could present a better late preservation of pulmonary function after lobectomy compared with healthy patients. This minimal deterioration or improvement of airway function seems to be related to preoperative obstructive indexes.


   References
Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 

  1. Beckles MA, Spiro SG, Colice GL, et al. Initial evaluation of the patient with lung cancer. Symptoms, signs, laboratory tests, and paraneoplastic syndromes. Chest 2003;123:97s-104s.
  2. Sekine Y, Iwata T, Chiyo M, et al. Minimal alteration of pulmonary function after lobectomy in lung cancer patients with chronic obstructive pulmonary disease. Ann Thorac Surg 2003;76:356-362.[Abstract/Free Full Text]
  3. Carretta A, Zannini P, Puglisi A, et al. Improvement of pulmonary function after lobectomy for non small cell lung cancer in emphysematous patients. Eur J Cardiothorac Surg 1999;15:602-607.[Abstract/Free Full Text]
  4. Santambrogio L, Nosotti M, Baisi A, et al. Pulmonary lobectomy for lung cancer: a prospective study to compare patients with forced expiratory volume in 1 s more or less than 80% of predicted. Eur J Cardiothorac Surg 2001;20:684-687.[Abstract/Free Full Text]
  5. Korst RJ, Ginsberg RJ, Ailawadi M, et al. Lobectomy improves ventilatory function in selected patients with severe COPD. Ann Thorac Surg 1998;66:898-902.[Abstract/Free Full Text]
  6. DeMeester SR, Patterson GA, Sundaresan RS, et al. Lobectomy combined with volume reduction for patients with lung cancer and advanced emphysema. J Thorac Cardiovasc Surg 1998;115:681-688.[Abstract/Free Full Text]
  7. Edward JG, Duthie DJ, Waller DA. Lobar volume reduction surgery: a method of increasing the lung cancer resection rate in patients with emphysema. Thorax 2001;56:791-795.[Abstract/Free Full Text]
  8. Markos J, Mullan BP, Hillman DR, et al. Preoperative assessment as a predictor of mortality and morbidity after lung resection. Am Rev Respir Dis 1989;139:902-910.[Medline]
  9. Boysen PG, Block AJ, Moulder PV. Relationship between preoperative pulmonary function tests and complications after thoracotomy. Surg Gynecol Obstet 1981;152:813-815.[Medline]
  10. Boushy SF, Billig DM, Noth LB, et al. Clinical course related to preoperative and postoperative pulmonary function in patients with bronchogenic carcinoma. Chest 1971;59:383-391.[Abstract/Free Full Text]
  11. Kearney DJ, Lee TH, Reilly JJ, et al. Assessment of operative risk in patients undergoing lung resection: importance of predicted pulmonary function. Chest 1994;105:753-759.[Abstract/Free Full Text]
  12. Ojo CT, Martinez F, Paine R, et al. Lung volume reduction surgery alters management of pulmonary nodules in patients with severe COPD. Chest 1997;112:1494-1500.[Abstract/Free Full Text]
  13. Gelb AF, Brenner M, McKenna RJ, et al. Lung function 12 months following emphysema resection. Chest 1996;110:1407-1415.[Abstract/Free Full Text]
  14. Choong CK, Meyers BF, Battaferano RJ, et al. Lung cancer resection combined with lung volume reduction in patients with severe emphysema. J Thorac Cardiovasc Surg 2004;127:1323-1331.[Abstract/Free Full Text]
  15. Mentzer SJ, Swanson SJ. Treatment of patients with lung cancer and severe emphysema. Chest 1999;116:477S-479S.[Abstract/Free Full Text]
  16. Hayashi K, Fukushima K, Sagara Y, et al. Surgical treatment for patients with lung cancer complicated by severe pulmonary emphysema. J Thorac Cardiovasc Surg 1999;47:583-587.
  17. Rozenshtein A, White CS, Austin JH, et al. Incidental lung carcinoma detected at CT in patients selected for lung volume reduction surgery to treat severe pulmonary emphysema. Radiology 1998;207:487-490.[Abstract/Free Full Text]
  18. Bennett W, Smith R. Segmental resection for bronchogenic carcinoma: a surgical alternative for the compromised patient. Ann Thorac Surg 1979;27:169-172.[Abstract/Free Full Text]
  19. Miller J, Hatcher C. Limited resection of bronchogenic carcinoma in the patient with marked impairment of pulmonary function. Ann Thorac Surg 1987;44:34-43.
  20. Hoffman T, Ransdell H. Comparison of lobectomy and wedge resection for carcinoma of the lung. J Thorac Cardiovasc Surg 1980;79:11-17.
  21. Errett L, Wilson J, Chiu R, et al. Wedge resection as an alternative procedure for peripheral bronchogenic carcinoma in poor-risk patients. J Thorac Cardiovasc Surg 1985;90:656-661.[Abstract]



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G. Varela, A. Brunelli, G. Rocco, M. F. Jimenez, M. Salati, and T. Gatani
Evidence of Lower Alteration of Expiratory Volume in Patients With Airflow Limitation in the Immediate Period After Lobectomy
Ann. Thorac. Surg., August 1, 2007; 84(2): 417 - 422.
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 Ann. Thorac. Surg.Home page
A. Brunelli, M. Refai, M. Salati, F. Xiume, and A. Sabbatini
Predicted Versus Observed FEV1 and DLCO After Major Lung Resection: A Prospective Evaluation at Different Postoperative Periods
Ann. Thorac. Surg., March 1, 2007; 83(3): 1134 - 1139.
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 ChestHome page
A. Brunelli, F. Xiume, M. Refai, M. Salati, R. Marasco, V. Sciarra, and A. Sabbatini
Evaluation of Expiratory Volume, Diffusion Capacity, and Exercise Tolerance Following Major Lung Resection: A Prospective Follow-up Analysis
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 J. Thorac. Cardiovasc. Surg.Home page
S. Baldi and E. Ruffini
Reply to the Editor
J. Thorac. Cardiovasc. Surg., July 1, 2006; 132(1): 216 - 216.
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 J. Thorac. Cardiovasc. Surg.Home page
A. Cesario, S. Di Toro, and P. Granone
Pulmonary lobectomy for cancer in patients with chronic obstructive pulmonary disease
J. Thorac. Cardiovasc. Surg., July 1, 2006; 132(1): 215 - 216.
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 J. Thorac. Cardiovasc. Surg.Home page
V. Porziella, A. Cesario, and P. Granone
Dor fundoplication after myotomy for achalasia: Useful, unnecessary, or harmful?
J. Thorac. Cardiovasc. Surg., July 1, 2006; 132(1): 216 - 217.
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