Effect of thoracotomy and lung resection on exercise capacity in patients with lung cancer

Background-Resection is the treatment of choice for lung cancer, but may ca use impaired cardiopulmonary function with an adverse effect on quality of Life. Few studies have considered the effects of thoracotomy alone on lung function, and whether the operation itself can impair subsequent exercise c apacity. Methods-Patients being considered for lung resection (n = 106) underwent fu ll static and dynamic pulmonary function testing which was repeated 3-6 mon ths after surgery (n = 53). Results-Thoracotomy alone (n = 13) produced a reduction in forced expirator y volume in one second (FEV1; mean (SE) 2.10 (0.16) versus 1.87 (0.15)1; p< 0.05). Wedge resection (n = 13) produced a nonsignificant reduction in tota l lung capacity (TLC) only. Lobectomy (n = 14) reduced forced vital capacit y (FVC), TLC, and carbon monoxide transfer factor but exercise capacity was unchanged. Only pneumonectomy (n = 13) reduced exercise capacity by 28% (P (V) over dot o(2) 23.9 (1.5) versus 17.2 (1.7) ml/min/kg; difference (95% C I) 6.72 (3.15 to 10.28); p<0.01) and three patients changed from a cardiac limitation to exercise before pneumonectomy to pulmonary limitation afterwa rds. Conclusions-Neither thoracotomy alone nor limited lung resection has a sign ificant effect on exercise capacity. Only pneumonectomy is associated with impaired exercise performance, and then perhaps not as much as might be exp ected.