Though several moderate sized studies demonstrate resection of lung cancer in patients with emphysema can be done safely, no larger series has been published to document safe resection in patients with severe emphysema. Further, many oncologists and pulmonologists refer their patients with lung cancer and emphysema for definitive radiotherapy. We have routinely resected lung cancers in patients with emphysema, and evaluated our results.
Patients with lung masses and severe emphysema (FEV1% < 70%) underwent thoracoscopic wedge resection. Patients with cancer underwent lobectomy if the margin of resection was inadequate. Data were analyzed for typical demographic features, type of surgery and length of stay, and need for subsequent hospitalization. Patients were considered to have died from surgical complications if they died within 60 days of surgery.
Three hundred twenty (320) patients with severe emphysema underwent resection (180 wedge/segments and 140 lobectomies). They ranged in age from 17 to 92 years of age. 98 patients had FEV1% <40%, 53 had FEV1% 41-50%, 64 had FEV1% between 51% and 60%, and 101 had FEV1% between 61 and 70%. Operative mortality and long-term survival are summarized below. No statistical difference between groups was found in the operative risk nor the 4-year survival. Pulmonary function in most patients with severe emphysema and upper lobe disease improved after surgery.
Improving surgical techniques and postoperative management make resection of lung cancer in patients with severe emphysema almost as safe as resection in patients with more normal lung function. Long-term survival is equivalent to national norms. Upper lobe resections typically improved lung function.
Resection of lung cancer in patients with severe emphysema is very safe in experienced hands, and gives survival results superior to chemoradiation. Surgical treatment should be the therapy of choice, even in patients with severe emphysema. FEV1% < 40FEV1% 41-50FEV1% 51-60FEV1% 61-70Wedge/Segments55324152Lobectomies46222456Periop mortality2.0%3.9%3.1%0%4-year survival57%43%52%58%
J.R. Roberts, None.