Thoracoscopic partial lung resection in patients with severe chronic obstructive pulmonary disease. A preliminary report.

Abstract

To determine if patients with severe chronic obstructive pulmonary disease can tolerate thoracoscopic partial lung resection. Patients with non-small-cell lung cancers were selected from 583 cases undergoing laser treatment. The parameters studied included sex, age, tumor size, spirometry (forced vital capacity, forced expiratory volume in 1 second), operating time, operative mortality rate, postoperative ventilatory time, and length of hospital stay. The follow-up period varied from 4 to 30 months. A private community hospital with nationwide referrals. Nine consecutive patients (five men, four women) were found to have lung cancer before (four patients) or at (five patients) surgery. Their mean (+/- SD) age was 71.2 +/- 3.8 years; tumor size, 3.3 +/- 1.6 cm; forced vital capacity, 2.04 +/- 0.50 L (49.7% +/- 10.2%); and forced expiratory volume in 1 second, 0.66 +/- 0.11 L (22.2% +/- 5.5%). With patients under general anesthesia with one-lung ventilation, the tumor was resected and coexisting diffuse bullae were treated by a contact neodymium:YAG laser. Four patients received adjuvant therapies: chemotherapy, one; radiation and chemotherapy, one; radiation, one; and brachytherapy, one. All patients tolerated surgery; there were no deaths. Mean (+/- SD) operating time was 4.9 +/- 1.4 hours; postoperative ventilatory time, 10.3 +/- 6.8 hours; and length of hospital stay, 15.2 +/- 13.2 days. One patient died of disease progression 4 months after surgery. There was one local recurrence and one distant metastasis. Four patients remained free of tumors. Patients with severe chronic obstructive pulmonary disease can tolerate thoracoscopic partial lung resection but an effort should be made to reduce local recurrence.