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J Thorac Cardiovasc Surg 2006;132:215-216
© 2006 The American Association for Thoracic Surgery
Letter to the Editor |
a Department of Surgical Sciences, Division of General Thoracic Surgery, Catholic University, Largo A. Gemelli 8, 00168 Rome, Italy
b Pulmonary Rehabilitation, IRCCS San Raffaele, Rome, Italy
(Email: alfcesario{at}rm.unicatt.it).
We have read with interest the report from Baldi and colleagues
1
reporting their experience with pulmonary lobectomy for lung cancer in patients with chronic obstructive pulmonary disease (COPD).
1
On the basis of their retrospective evaluation of 137 patients, they concluded that patients with mild-to-severe COPD could have a better late preservation of pulmonary function after lobectomy than healthy patients. As discussed in a very precise way by the authors, this fact is related to a general improvement of the airway caliber and elastic recoil that could be, in its turn, related to relief of hyperinflation, chest wall mechanics, or both, even if in the nonemphysematous lung. In addition, resection of dead space could have its role.
We would like to briefly comment on these figures, trying to relate them to the possible role a pulmonary rehabilitation (PR) program might have in this kind of surgical population, and kindly ask for the authors to disclose their point of view according to their experience.
Today there is body of evidence regarding the efficacy of PR in the comprehensive management of patients with respiratory disease, and PR programs are practiced worldwide.
2
Positive results in terms of improvement in dyspnea, exercise capacity, and quality of life are recognized in chronic obstructive and nonobstructive pulmonary disease, including COPD, cystic fibrosis, and restrictive thoracic disease.
3,4
Our group has a timely established interest in the issue of PR applied to patients who have undergone (or are candidates for) resection for lung cancer, and we have reported evidence that patients who underwent PR after pulmonary resection demonstrated a better improvement than those who, at discharge from the surgical unit, did not attend any postoperative rehabilitation protocol. In fact, we have reported that an early postoperative rehabilitative intervention prevents deterioration and speeds up recovery of function, with direct effects on ventilatory, gas exchange, and hemodynamic parameters (work of breathing, lung compliance, alveolar-arterial difference, maximum oxygen consumption, arterial oxygen tension, heart rate, arterial lactate concentration, cardiac index, and pulmonary artery pressure) and little or no significant effect on static and dynamic lung volumes, according to previously outlined experiences.
5
Further analysis (data submitted for publication) of our experience supports this evidence. Because it appears that only patients with mild-to-severe COPD obtain an improvement in terms of lung volumes (related to the preoperative COPD index also)
1
from the removal of lung parenchyma associated with resection for cancer, we would like the authors to comment on the fact that a postoperative rehabilitation program adopted in these patients could improve ventilatory, hemodynamic, and gas exchange parameters concurring to a better clinical outcome and quality of life status.
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