Determination of the upper safety limit for lung resection

Abstract

In lobectomy using animals, a stepwise gradual increase in the volume of lung resection is encountered by elevation of the pulmonary arterial pressure followed by reduction of the cardiac output, when lung resection exceeds a certain limit in volume.In a unilateral pulmonary arterial occlusion test, we compared the exercise-loaded cardiopulmonary function with the postoperative cardiopulmonary function.In consideration of the cardiopulmonary reserve capacity, the physiological safety limit of the lung resection was found to correspond to the total pulmonary vascular resistance of 700 dyne.sec.cm-5/m2 in the contralateral lung.We usually perform lung resection on lung cancer patients regardless of age, provided that they preserve cardiopulmonary function within the above limit.However, patients with this safety limit easily develop postoperative lung complication. The upliftment of the safety limit in lung resection is considered to depend on prevention of postoperative lung complication. This paper pointed out that a large number of resectable cases are included in lung cancer patients in whom lung resection is contraindicated for preservation of ventilatory function.