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Clinical Investigations: SURGERY |

Exercise Capacity of Thoracotomy Patients in the Early Postoperative Period*

Shinichiro Miyoshi, MD; Tatsuya Yoshimasu, MD; Taeko Hirai, MT; Issei Hirai, MD; Shinji Maebeya, MD; Toshiya Bessho, MD; Yasuaki Naito, MD
Author and Funding Information

* From the General Thoracic Surgery (Dr. Miyoshi), Department of Surgery, Osaka University Graduate School of Medicine, Osaka, Japan; and Thoracic Surgery (Drs. Yoshimasu, Hirai, Maebeya, Bessho, Naito, and Ms. Hirai), Wakayama Medical College, Wakayama, Japan.

Correspondence to: Shinichiro Miyoshi, MD, 2–2 Yamadaoka, Suita, Osaka, Japan, 565-0871;



Chest. 2000;118(2):384-390. doi:10.1378/chest.118.2.384
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Objective: We investigated the mechanism involved with the initial drop and subsequent recovery of exercise capacity in the early postoperative period of thoracotomy patients.

Methods: Sixteen patients (13 who had undergone lobectomy, 3 who had undergone pneumonectomy) underwent a routine pulmonary function test (PFT) and a cardiopulmonary exercise test preoperatively, within 14 postoperative days (POD; post-1; mean ± SD, 9 ± 2 POD), and after 14 POD (post-2; mean, 26 ± 12 POD).

Results: After surgery on post-1, PFT results of FVC, FEV1, and maximum ventilatory volume (MVV) significantly decreased. Oxygen uptake (V̇o2) at a venous blood lactate level of 2.2 mmol/L (La-2.2), which was adopted as the empirical anaerobic threshold, and maximum V̇o2 (V̇o2max) decreased significantly to 88.2 ± 7.9% and 73.1 ± 15.4% of the preoperative values, respectively. La-2.2 min ventilation (V̇e)/ MVV and maximum V̇e (V̇emax)/MVV increased significantly from 0.36 ± 0.08 to 0.66 ± 0.20 and from 0.58 ± 0.14 to 0.80 ± 0.09, respectively. On post-2, though La-2.2 V̇o2 did not change, V̇o2max improved significantly to 81.5 ± 19.7% of the preoperative values, in association with significant increases in maximal tidal volume and V̇emax, which were produced by significant increases in the PFT results. La-2.2 V̇e/MVV also decreased significantly to 0.49 ± 0.13, which indicated a sufficient recovery of respiratory reserve at submaximal exercise.

Conclusions: The initial drop of exercise capacity after lung resection seems to be derived from both circulatory and ventilatory limitations. Further, the subsequent recovery within 1 month seems to be produced by an improvement in ventilatory limitation, which was caused by the surgical injury to the chest wall.

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