PULMONARY-FUNCTION AND EXERCISE CAPACITY AFTER LUNG RESECTION

The influence of pulmonary resection on functional capacity can be ass essed in different ways, The aim of this study was to compare the effe ct of lobectomy and pneumonectomy on pulmonary function tests (PFT), e xercise capacity and perception of symptoms. Sixty eight patients unde rwent functional assessment with PFT and exercise testing before (Preo p), and 3 and 6 months after lung resection, In 50 (36 males and 14 fe males; mean age 61 yrs) a lobectomy was performed and in 18 (13 males and 5 females; mean age 59 yrs) a pneumonectomy was performed. Three m onths after lobectomy, forced vital capacity (FVC), forced expiratory volume in one second (FEV(1)), total lung capacity (TLC), transfer fac tor of the lungs for carbon monoxide (TL,CO) and maximal oxygen uptake (V'O-2,max) were significantly lower than Preop values, increasing si gnificantly from 3 to 6 months after resection, Three months after pne umonectomy, all parameters were significantly lower than Preop values and significantly lower than postlobectomy values and did not recover from 3 to 6 months after resection, At 6 months after resection signif icant deficits persisted in comparison with Preop: for FVC 7% and 36%, FEV(1) 9% and 34%, TLC 10% and 33% for lobectomy and pneumonectomy, r espectively; and V'O-2,max 20% after pneumonectomy only, Exercise was limited by leg muscle fatigue in 53% of all patients at Preop. This wa s not altered by lobectomy, but there was a switch to dyspnoea as the Limiting factor after pneumonectomy (61%, of patients at 3 months and 50% at 6 months after resection), Furthermore, pneumonectomy compared to lobectomy led to a significantly smaller breathing reserve (mean+/- SD) (28+/-13 vs 37+/-16% at 3 months; and 24+/-11% vs 33+/-12% at 6 mo nths post resection) and lower arterial oxygen tension at peak exercis e 10.1+/-1.5 vs 11.5+/-1.6 kPa (76+/-11 vs 86+/-12 mmHg) at 3 months; 10.1+/-1.3 vs 11.3+/-1.6 kPa (76+/-10 vs 85+/-12 mmHg) at 6 months pos tresection, We conclude that measurements of conventional pulmonary fu nction tests alone overestimate the decrease in functional capacity af ter lung resection, Exercise capacity after lobectomy is unchanged, wh ereas pneumonectomy leads to a 20% decrease, probably due to the reduc ed area of gas exchange. (C)ER Journals Ltd 1996.