Extending Resectability for Carcinoma of the Lung in Patients with Impaired Pulmonary Function

Abstract

A total of 49 consecutive patients who had resection for carcinoma of the lung is reported. Twenty-two of the patients had marginal pulmonary function, forced expiratory flow rate less than 1.0 liter per second, and forced vital capacity in the first second less than 70%. Of the total group, 23 were more than 60 years old, and 13 of these had marginal pulmonary function. Thirteen patients had pneumonectomy, with no hospital mortality; 30 had lobectomy, with 3 hospital mortalities; and 6 had wedge resection, with 1 hospital mortality. No patients had pulmonary insufficiency in the postoperative period or died of pulmonary insufficiency. The selection of patients was based on a combination of data on flow rates, vital capacity, and regional ventilation perfusion scans. The good results may be due to the fact that despite major obstructive disease of the airway, vital capacity was preserved (92 ± 16% of predicted). Intraoperative use of the Robertshaw tube, preservation of as much lung as possible, and use of local analgesia during the postoperative period were apparent contributors to the low mortality and the absence of pulmonary insufficiency.