N. Tsubota et al., THE SUPERIORITY OF EXERCISE TESTING OVER SPIROMETRY IN THE EVALUATIONOF POSTOPERATIVE LUNG-FUNCTION FOR PATIENTS WITH PULMONARY-DISEASE, SURGERY TODAY-THE JAPANESE JOURNAL OF SURGERY, 24(2), 1994, pp. 103-105
Thoracic surgeons have often been embarrassed by the discrepancy betwe
en an improvement in symptoms and the unchanged or even worse results
of spirometry in postoperative patients with either bullae or inflamma
tory lung disease. Forty-four patients with lung diseases, who underwe
nt a total of 47 operations, were categorized as follows: 12 cases of
empyema, 16 cases of giant bulla (undergoing surgery a total of 19 tim
es), 4 cases of bronchiectasis, and 12 cases of other miscellaneous di
seases. All patients were tested preoperatively and again 4-6 months a
fter surgery on both the spirometer and treadmill exercise tests. The
forced vital capacity (FVC) and forced expiratory volume (FEV(1.0)) re
sults were as follows: the empyema group 1.82 +/- 0.52 liters preopera
tively to 1.93 +/- 0.69 liters postoperatively and 1.47 +/- 0.44 liter
s to 1.56 +/- 0.53 liters, respectively; and the giant bulla group, 3.
49 +/- 0.96 liters to 3.35 +/- 0.77 liters and 2.35 +/- 0.96 liters to
2.48 + 0.69 liters, respectively. However, the exercise time was prol
onged in the empyema group from 6.00 +/- 3.77 min to 8.33 +/- 3.80 min
(P < 0.01) and in the giant bulla group from 11.83 +/- 3.71 min to 12
.92 +/- 2.84 min (P < 0.05). It was thus concluded that exercise testi
ng should be chosen for the postoperative evaluation of patients with
inflammatory pulmonary disease and giant bullae, especially if any dis
crepancies are seen between spirometry and performance status, because
on the basis of our results, it appears that the benefits obtained by
surgery are best measured by the dynamic values of exercise testing a
nd not by the static values of spirometry at rest.