Improved ventilatory function after combined operation for pulmonary emphysema and lung cancer

Background: Smoking is the leading cause of both lung cancer and emphysema. Therefore, some patients with stage I ansi II disease will present with co ntra-indications to resection including a predicted postoperative FEV1 of l ess than 0.81 or a VO(2)max of less than 10 ml/kg/min. Recently, lung volum e reduction surgery (LVRS) has re-emerged in the management of emphysema wi th excellent results. Methods and Patients: 2 patients are reported with lung cancer in the left lower lobe and emphysematous destruction in both upper lobes. They, respect ively, had a predicted postoperative FEV1 of 0.921 l and 0.685 l. No metast ases were present. Pre-operatively, a COPD index of 0.9 and 0.7 was calcula ted. A left lower lobectomy together with volume reduction of the left uppe r lobe was performed through a standard posterolateral thoracotomy. Results: Pathological examination showed, respectively, stage IIb and stage Ib disease. The postoperative course was uneventful and 3 months later a F EV1 of 1.441 for patient 1 and 1.041 for patient 2 were recorded. Conclusion: These findings suggest that pulmonary function criteria for pul monary resection have to be revised when patients can undergo simultaneous lung cancer resection and LVRS. The pre-operatively calculated COPD index c an be used to predict which patients may not have a decrease in ventilatory function.