Impact of lobectomy for non-small-cell lung cancer on respiratory function in octogenarian patients with mild to moderate chronic obstructive pulmonary disease☆

Abstract

To assess the long-term impact of standard lobectomy on respiratory function in octogenarian patients with mild/moderate chronic obstructive pulmonary disease (COPD). We reviewed all octogenarians (n=38), who underwent lobectomy for stage I-II non-small-cell lung cancer (NSCLC) from 2000 to 2006. Inclusion criteria were: Tiffenau index<0.7, no adjuvant therapies, smoking cessation after surgery, spirometric data available after 12±3 months from surgery in the absence of relapsing disease. After excluding 14 patients (three died perioperatively), 24 fulfilled the inclusion criteria. The median preoperative forced expiratory volume in 1s (FEV1) was 80% (range 56.7-100%). The mean change in FEV1 after lobectomy resulted in a loss of 11% (range -32% to +7%, p=0.004). Considering two groups on the basis of median FEV1 (group 1: FEV1≤80%, group 2: FEV1>80%), mean FEV1 loss after surgery was 7.9% in group 1 and 14.9% in group 2, respectively (p=0.17). No statistical differences were found between the two groups in changes after surgery of forced vital capacity (FVC), arterial oxygen and carbon-dioxide tension. Diffusion capacity of the lung for carbon monoxide (DLCO)% loss was significantly higher in group 2 compared with group 1 (-22.5% vs +1.5%, p=0.001). Six patients showed an improvement of postoperative FEV1: all had a preoperative FEV1 less than 60%, an upper or homogeneous pattern of emphysema, and received an upper lobectomy. In group 2, the FEV1 loss was not affected by the type of lobectomy whereas in group 1, the resection of lower lobe was associated to a major FEV1 loss (-14.5% vs +5.3%, p=0.05). Octogenarians with lower preoperative FEV1% have a better late preservation of pulmonary function after lobectomy. Upper lobectomy seems to produce a lung-volume reduction effect, leading to an improvement in the expiratory volume in patients with higher airflow obstruction.