PURPOSE:Patients with lung cancer and severe emphysema have not been offered surgical treatment for two reasons. First, some believe that the operative mortality for these patients is increased. However, several reports have shown that these patients can undergo resection safely in experienced hands. Second, many physicians believe that even if their emphysematous patients survive surgery, they would die from their emphysema, that their 5-year survival would be less than those with more normal lung function. Two developments affect this decisionùthe almost simultaneous development of lung volume reduction surgery and thoracoscopic surgery. We have routinely offered patients with emphysema and lung cancer thoracoscopic resection and present those results below.
METHODS:All patients with lung cancer underwent routine preoperative pulmonary function testing including residual volume and diffusing capacity. Standard demographic data were harvested, as were postoperative issues, such as length of stay, postoperative complications, and operative mortality. Long term-survival was determined by first chart review, and then by the Social Security Death Index. Statistics were evaluated in standard fashion, using Student’s t test to compare means, and chi-square for proportions. Significance levels were set at 0.05.
RESULTS:583 patients were evaluated. Patients with emphysema tended toward longer lengths of stay (5.1 days versus 3.9 days) that did not reach statistical significance. No differences in operative mortality, nor long-term survival were seen (see graphs). No operative deaths occurred in the last 100 patients in either arm of the study.
CONCLUSION:Severe emphysema did not cause increased operative mortality nor diminished long-term survival in these large cohorts of patients treated with minimally invasive resection.
CLINICAL IMPLICATIONS:Because the other options for the treatment of patients with lung cancer are ineffective (radiation alone gives a 5-year survival of 5–10%, while chemoradiation gives a 5-year survival of only 15–20%), patients with emphysema and lung cancer should be given the option of thoracoscopic surgical resection.
DISCLOSURE:Aravindhan Sriharan, No Financial Disclosure Information; No Product/Research Disclosure Information