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Outcome of Lung Surgery : What Patients Don’t Like FREE TO VIEW

Gaetano Rocco, MD, FCCP; Roger Vaughan, MD
Author and Funding Information

Affiliations: Sheffield, United Kingdom
 ,  Dr. Rocco and Dr. Vaughan are from the Department of Thoracic Surgery, Northern General Hospital, Sheffield.

Correspondence to: Gaetano Rocco, MD, FCCP, Department of Thoracic Surgery, Chesterman Unit, Northern General Hospital, Herries Rd, Sheffield S5 7AU, United Kingdom; e-mail: grocco@tany.fsnet.co.uk

Chest. 2000;117(6):1531-1532. doi:10.1378/chest.117.6.1531
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The article by Cykert et al, published in this issue of CHEST (see page 1551), is focused on patients’ preferences regarding the possible outcome of lung surgery, and their impact on the final decision of undergoing surgical treatment. The conclusions of this study—if confirmed by larger series—may effect a change in everyday surgical practice.

Firstly—covering a methodologic aspect—it might suggest a revision of standard methods of evaluating postsurgical functional results, not only considering the immediate postoperative period (30 days postoperatively or “transient states”) but, also, long-term functional results—so-called “fixed functional outcomes”—which were felt to be onerous enough to deter patients from the surgical option, and have the potential to expose both the patients and the community to increased health costs.

Secondly—covering a functional aspect—it will help refine the search for predictors of cardiopulmonary reserve in surgical candidates in order to decrease the risk for long-term physical disability. In other words, preoperative workup should predict the long-term possibility for oxygen dependency and limitation in ambulation and routine daily activities. Put it into perspective, the need for a more comprehensive preoperative evaluation including additional tests (ie, assessment of maximal oxygen consumption, 6-min walk test), nowadays routinely contemplated only in the setting of the so-called functional surgery, such as lung transplantation and lung volume reduction surgery, may come into view. We could be facing soon the sunset of the “FEV1-based preoperative workup” era.

Thirdly—covering a medicolegal or ethical aspect—it might provide the surgeon with an important clue of what a dreadful complication could be conceived from the patient’s perspective. The medicolegal consequences of this study may impact the way of collecting informed consent. Emphasis will be put on what the patients perceive as despicable in terms of long-term functional (“fixed”) complications. The potential benefit of an operation—in terms of survival and/or symptom relief—should be weighed against the possibility of these long-term complications to occur. Each patient’s situation will need to be more thoroughly evaluated on an individual basis by a multidisciplinary team of dedicated physicians.

Needless to say, the impact of the above-mentioned predictors of long-term functional outcome on the final decision for surgery remains to be determined, especially when resection is required to treat lung cancer. It might also well be that, in the future, more solid efforts will be made to follow up cancer patients, not only to determine raw survival figures but also to assess their interim postsurgical quality of life. Some reports on esophageal surgery have already emphasized this issue.1

Although the role of a detailed statistical analysis of subjective measurements—focused on theoretical scenarios picturing different treatment outcomes—is debatable, especially until larger series will be made available to evaluation, the potential for determining the extent of patients’ aversion to long-term complications remains of some appeal.

In conclusion, this study may result in a new interpretation of the surgical profession by altering the way surgeons conceive the benefit of an operation, the preoperative workup, the collection of informed consent, and the evaluation of postsurgical outcomes, thus representing a major thrust towards evidence-based surgery.


McLarty, AJ, Deschamps, C, Trastek, VF, et al (1997) Esophageal resection for cancer of the esophagus: long-term function and quality of life.Ann Thorac Surg63,1568-1572. [CrossRef] [PubMed]




McLarty, AJ, Deschamps, C, Trastek, VF, et al (1997) Esophageal resection for cancer of the esophagus: long-term function and quality of life.Ann Thorac Surg63,1568-1572. [CrossRef] [PubMed]
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