LUNG-VOLUME REDUCTION SURGERY ALTERS MANAGEMENT OF PULMONARY NODULES IN PATIENTS WITH SEVERE COPD

Objective: To examine the role of lung volume reduction surgery (LVRS) in expanding tile treatment options for patients with single pulmonar y nodules and emphysema. Methods: Retrospective review of all patients undergoing LVRS at the University of Michigan between January 1995 an d June 1996. Those undergoing simultaneous LVRS and resection of a sus pected pulmonary malignancy formed the study group and underwent histo ry and physical examination, pulmonary function tests, chest radiograp hy, and high-resolution CT of the chest. If heterogeneous emphysema wa s found, cardiac imaging and single-photon emission CT perfusion lung scanning were performed. All study patients participated in pulmonary rehabilitation preoperatively. Age-and sex-matched patients who had un dergone standard lobectomy for removal of pulmonary: malignancy during the same period formed the control group. Results: Of 75 patients who underwent LVRS, 11 had simultaneous resection of a pulmonary nodule. In 10 patients, the nodules were radiographically apparent with 1 demo nstrating central calcification. Histologic evaluation revealed six gr anulomas, two hamartomas, and three neoplastic lesions (one adenocarci noma, one squamous cell, and one large cell carcinoma). Preoperative F EV1 was 26.18 +/- 2.49% predicted in the LVRS group and 81.36 +/- 6.07 % predicted (p = 0.000001) in the control group, and the FVC was 65.27 +/- 5.17% predicted vs 92.18 +/- 5.53% predicted (p = 0.002). Two LVR S patients had a PaCO2 >45 mm Hg while 11 exhibited oxygen desaturatio n during a G-min walk test. Postoperative complications occurred in tw o LVRS patients and three control patients. The mean length of stay in the LVRS group (7.55 +/- 1.10 days) was not different than in the con trol group (8.81 +/- 1.56 days). Three months after LVRS and simultane ous nodule resection, FEV, rose by 47%, FVC by 25%, and all study pati ents noted less dyspnea as measured by transitional dyspnea index. Con clusions: Simultaneous LVRS and resection of a suspected bronchogenic carcinoma is feasible and associated with minimal morbidity and signif icantly improved pulmonary function and dyspnea.