LOBECTOMY COMBINED WITH VOLUME REDUCTION FOR PATIENTS WITH LUNG-CANCER AND ADVANCED EMPHYSEMA

Objective: Early-stage lung cancer is best treated by anatomic pulmona ry resection. Patients with lung cancer and severe emphysema are often denied resection or are offered only limited, nonanatomic resections when established pulmonary function criteria for lobectomy are not met , Recently, with the introduction of the volume reduction operation, s elected patients with disabling emphysema have undergone excision of a pproximately 30% of the most destroyed lung tissue and have subsequent ly demonstrated subjective and objective improvement in pulmonary func tion, Using these principles, we elected to combine anatomic lobectomy with volume reduction in a select group of patients with both emphyse ma and lung cancer who would not otherwise be candidates for pulmonary resection, Methods: Five patients with severe emphysema and suspected or proven lung cancers, who were poor candidates for anatomic lobecto my by traditional criteria but mere good candidates for volume reducti on, underwent lobectomy combined with volume reduction of one or more additional lobes, Results: All five patients having lung volume reduct ion and anatomic lobectomy for early-stage primary lung cancer did wel l postoperatively. Furthermore, each patient has demonstrated subjecti ve and objective improvement in respiratory function on serial postope rative studies, Conclusions: Selected patients with disabling emphysem a and suitable anatomy for volume reduction, who have a lung cancer si tuated in destroyed lung tissue, may benefit from combined lobectomy a nd volume reduction, The introduction of the volume reduction operatio n has added a new factor in the algorithm for the evaluation and treat ment of lung cancer in selected patients with advanced emphysema.