THORACOSCOPIC PARTIAL LUNG RESECTION IN PATIENTS WITH SEVERE CHRONIC OBSTRUCTIVE PULMONARY-DISEASE - A PRELIMINARY-REPORT

Objective: To determine if patients with severe chronic obstructive pu lmonary disease can tolerate thoracoscopic partial lung resection. Des ign: Patients with non-small-cell lung cancers were selected from 583 cases undergoing laser treatment. The parameters studied included sex, age, tumor size, spirometry (forced vital capacity, forced expiratory volume in 1 second), operating time, operative mortality rate, postop erative ventilatory time, and length of hospital stay. The follow-up p eriod varied from 4 to 30 months. Setting: A private community hospita l with nationwide referrals. Patients: Nine consecutive patients (five men, four women) were found to have lung cancer before (four patients ) or at (five patients) surgery. Their mean (+/-SD) age was 71.2+/-3.8 years; tumor size, 3.3+/-1.6 cm; forced vital capacity, 2.04+/-0.50 L . (49.7%+/-10.2%); and forced expiratory volume in 1 second, 0.66+/-0. 11 L (22.2%+/-5.5%). Interventions: With patients under general anesth esia with one-lung ventilation, the tumor was resected and coexisting diffuse bullae were treated by a contact neodymium:YAG laser. Four pat ients received adjuvant therapies: chemotherapy, one; radiation and ch emotherapy, one; radiation, one; and brachytherapy, one. Main Outcomes : All patients tolerated surgery; there were no deaths. Mean (+/-SD) o perating time was 4.9+/-1.4 hours; postoperative ventilatory time, 10. 3+/-6.8 hours; and length of hospital stay, 15.2+/-13.2 days. Results: One patient died of disease progression 4 months after surgery. There was one local recurrence and one distant metastasis. Four patients re mained free of tumors. Conclusion: Patients with severe chronic obstru ctive pulmonary disease can tolerate thoracoscopic partial lung resect ion but an effort should be made to reduce local recurrence.