THE INFLUENCE OF CARDIOPULMONARY FUNCTION ON OUTCOME OF VETERANS UNDERGOING RESECTIONAL THERAPY FOR LUNG-CANCER

Background. The unknown but presumably poor preoperative cardiopulmona ry function of U.S, Armed Forces veterans with bronchogenic cancer may dissuade surgeons performing necessary major lung resection, The purp ose of this study was to investigate the relationship between preopera tive cardiopulmonary risk and the outcome of veterans undergoing pulmo nary resection for bronchogenic carcinoma. Methods. A retrospective ch art review a-as performed on 79 veterans who underwent lung resection for bronchogenic cancer between March 1990 and June 1995 Preoperative cardiac function was assessed by 1) history of heart disease (myocardi al infarction, previous open heart surgery, and hypertension), 2) elec trocardiogram, EKG, and 3) transthoracic echocardiography, TTE (ejecti on fraction and left ventricular wall motion abnormalities). Pulmonary reserve was evaluated by 1) history of lung disease (active smoking, known chronic obstructive pulmonary disease, COPD), and 2) spirometry (forced expiratory volume in 1 second, FEV1, and minute ventilation vo lume, MVV). Resections were performed by standard pulmonary techniques and follow-up data was available in all patients. Results. All patien ts were males except one, with a mean age of 66 +/- 1.0 yrs (range=32 to 81 yrs). Fifty-one patients (64.6%) had a history of COPD while one -third of the veterans were smoking and using excessive alcohol just p rior to surgery. Twenty-four patients (29%) had abnormal preoperative EKG and only 10 (15%) had prior myocardial infarction, Eleven patients (13.9%) had undergone previous coronary bypass surgery. Average preop erative left ventricular ejection fraction was 63 +/- 2% (range=41 to 80%) and left ventricular wall motion abnormalities were present in on ly 6 patients (8%), Mean preoperative FEV, was 2.2 +/- 0.1 L (range=0. 6-4.1 L) and MVV was 87 +/- 4 L/min (range = 26-198 L/min). A lobectom y was performed in 68 patients (86.1%), pneumonectomy in 10 (12.7%), a nd wedge resection in 1 (1.2%). The most common types of cancer were s quamous cell. (36 patients) and adenocarcinoma (31 patients). While pu lmonary complications (atelectasis, prolonged air leak, pneumonia) occ urred in 8 patients (10%), only two (3%) suffered nonpulmonary complic ations (ischemic bowel disease). For all veterans with bronchogenic ca nter, early (30-day) mortality after major lung resection was 3.9% (3/ 79): 1.5% (1/68) after lobectomy, and 20% (2/10) after pneumonectomy ( p=not significant). Overall survival at 5 years was 39.5%. Conclusions . Preoperative cardiopulmonary risk for veterans with bronchogenic can cer is acceptable and lung resection can be performed with good outcom es in this distinct patient population.