LOBECTOMY IMPROVES VENTILATORY FUNCTION IN SELECTED PATIENTS WITH SEVERE COD

Background. Patients often undergo limited resection instead of lobect omy for non-small cell lung cancer because of a low preoperative force d expiratory volume in 1 second (FEV1). Our goal is to define criteria that will preoperatively identify a group of patients who will not lo se further function after lobectomy. Methods. Patients who underwent l obectomy with a preoperative FEV1 of less than 80% of predicted were r etrospectively identified. Data collected included preoperative and po stoperative pulmonary function tests, age, sex, the lobe resected, and preoperative ventilation-perfusion scan result. Results. Thirty-two p atients were included in this study. The median preoperative FEV1 was 60% of predicted (1.65 L) and the mean change in FEV1 was a loss of 7. 8% after lobectomy. The patients were divided into two groups. Group 1 (n = 13) had a preoperative FEV1 of less than or equal to 60% of pred icted (median, 49%; 1.35 L) combined with an FEV1 to forced vital capa city ratio of less than or equal to 0.6. Group 2 (n = 19) includes all other patients (median preoperative FEV1, 69% of predicted; 1.87 L). The mean changes in FEV, after lobectomy were +3.7% and -15.7% for gro ups 1 and 2, respectively (p < 0.005). A chronic obstructive pulmonary disease index was defined and then calculated for each patient. The r elationship between this index and the change in FEV1 after lobectomy for all 32 patients appears linear (r = -0.43; p = 0.015). Conclusions . Patients with a very low preoperative FEV1 and FEV1 to forced vital capacity ratio are less likely to lose ventilatory function after lobe ctomy and may actually improve it. (Ann Thorac Surg 1998;66:898-902) ( C) 1998 by The Society of Thoracic Surgeons.