Artikel
Onkologische Lungenresektionen bei Patienten mit hochgradig eingeschränkter Lungenfunktion
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Autoren
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C. Aigner
- Medizinische Universität Wien, Österreich
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G. Lang
- Medizinische Universität Wien, Österreich
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S. Taghavi
- Medizinische Universität Wien, Österreich
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J.H. Ankersmit
- Medizinische Universität Wien, Österreich
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B. Moser
- Medizinische Universität Wien, Österreich
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M.A. Reza Hoda
- Medizinische Universität Wien, Österreich
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K. Hötzenecker
- Medizinische Universität Wien, Österreich
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P. Nierlich
- Medizinische Universität Wien, Österreich
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W. Klepetko
- Medizinische Universität Wien, Österreich
| Veröffentlicht: | 30. September 2010 |
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Gliederung
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Background: Significantly impaired lung function has long been considered a contraindication for pulmonary resections. In view if the knowledge gained from lung volume reduction surgery in emphysema patients this paradigm has changed. Lung cancer patients with reduced lung function and hyperinflation who are considered inoperable by classic criteria might experience less loss of lung function than expected or even improve after cancer resection.
Methods: All patients with severely reduced lung function (GOLD stages III and IV, FEV1% <50%) undergoing lung cancer resection from 1/2006 to 8/2008 at our department were retrospectively analyzed. Postoperative predicted FEV1% was calculated according to the number of resected segments and compared to actual postoperative lung function values.
Results: 31 patients (20 male, 11 female, mean age 61+8 years) with an FEV1% <50% underwent lung resections for malignancy during the observation period. 27 patients were in GOLD stage III and 4 patients in GOLD stage IV. Average number of resected segments was 3.1+2.5 (16 segmental resections/enucleations, 11 lobectomies, 1 bilobectomy, 3 pneumonectomies). Preoperative mean PaCO2 level was 40.2+4.8 mmHg (range 31.1 to 49.0). Mean preoperative FEV1% was 39.5+8.8%. Mean postoperative predicted FEV1% was 32.5+8.8%. Actual postoperative FEV1% was significantly better with 40.2+10.1% (p=0.004). Mean preoperative residual volume (RV) was 218+58% and decreased to 206+45% postoperatively, which however was not significant (p=0.1). 5 patients required prolonged ventilation of more than 24 hours postoperatively. No perioperative in-hospital mortality was observed.
Conclusions: Pulmonary resections for malignancy can safely be performed in carefully selected patients with severely impaired lung function. Postoperative lung function parameters are frequently better than the predicted values and might even improve compared to preoperative lung function due to a volume reduction effect.
Disclosure: No significant relationships.
