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A Journal on Cardiac, Vascular and Thoracic Surgery

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The Journal of Cardiovascular Surgery 1998 August;39(4):497-501

language: English

The influ­ence of car­di­o­pul­mo­nary func­tion on out­come of vet­e­rans under­go­ing resec­tion­al ther­a­py for ­lung can­cer

Can­ver C. C., Cool­er S. D., Nich­ols R. D.

From the Section of Cardiothoracic Surgery William S. Middleton Memorial Veterans Hospital University of Wisconsin School of Medicine Madison, Wisconsin, USA


Background. The ­unknown but pre­sum­ably ­poor pre­op­er­a­tive car­di­o­pul­mo­nary func­tion of U.S. Armed Forces vet­e­rans ­with bron­cho­gen­ic can­cer may dis­suade sur­geons per­form­ing nec­es­sary ­major ­lung resec­tion. The pur­pose of ­this ­study was to inves­ti­gate the rela­tion­ship ­between pre­op­er­a­tive car­di­o­pul­mo­nary ­risk and the out­come of vet­e­rans under­go­ing pul­mo­nary resec­tion for bron­cho­gen­ic car­ci­no­ma.
Methods. A ret­ro­spec­tive ­chart ­review was per­formed on 79 vet­e­rans who under­went ­lung resec­tion for bron­cho­gen­ic can­cer ­between March 1990 and June 1995. Preoperative car­diac func­tion was ­assessed by 1) his­to­ry of ­heart dis­ease (myo­car­dial infa­ro­tion, pre­vi­ous ­open ­heart sur­gery, and hyper­ten­sion), 2) elec­tro­car­di­o­gram, EKG, and 3) trans­tho­rac­ic ech­o­car­di­og­ra­phy, TTE (ejec­tion frac­tion and ­left ven­tric­u­lar ­wall ­motion abnor­mal­ities). Pulmonary ­reserve was eval­u­at­ed by 1) his­to­ry of ­lung dis­ease (­active smok­ing, ­known chron­ic obstruc­tive pul­mo­nary dis­ease, ­COPD), and 2) spi­rom­e­try (­forced expir­a­to­ry vol­ume in 1 sec­ond, FEV1, and min­ute ven­ti­la­tion vol­ume, MVV). Resections ­were per­formed by stan­dard pul­mo­nary tech­niques and fol­low-up ­data was avail­able in all ­patients.
Results. All ­patients ­were ­males ­except one, ­with a ­mean age of 66±1.0 yrs (­range=32 to 81 yrs). Fifty-one ­patients (64.6%) had a his­to­ry of ­COPD ­while one-­third of the vet­e­rans ­were smok­ing and ­using exces­sive alco­hol ­just ­prior to sur­gery. Twenty-­four ­patients (29%) had abnor­mal pre­op­er­a­tive EKG and ­only 10 (15%) had ­prior myo­car­dial infarc­tion. Eleven ­patients (13.9%) had under­gone pre­vi­ous cor­o­nary ­bypass sur­gery. Average pre­op­er­a­tive ­left ven­tric­u­lar ejec­tion frac­tion was 63±2% (range=41 to 80%) and ­left ven­tric­u­lar ­wall ­motion abnor­mal­ities ­were ­present in ­only 6 ­patients (8%). Mean pre­op­er­a­tive FEV1 was 2.2±0.1 L (­range=0.6-4.1 L) and MVV was 87±4 L/min (­range=26-198 L/min). A lobec­to­my was per­formed in 68 ­patients (86.1%), pneu­mo­nec­to­my in 10 (12.7%), and ­wedge resec­tion in 1 (1.2%). The ­most com­mon ­types of can­cer ­were squa­mous ­cell (36 ­patients) and aden­o­car­cin­o­ma (31 ­patients). While pul­mo­nary com­pli­ca­tions (ate­lec­ta­sis, pro­longed air ­leak, pneu­mo­nia) ­occurred in 8 ­patients (10%), ­only two (3%) suf­fered non­pul­mo­nary com­pli­ca­tions (ischem­ic bow­el dis­ease). For all vet­e­rans ­with bron­cho­gen­ic can­cer, ear­ly (30-day) mor­tal­ity ­after ­major ­lung resec­tion was 3.9% (3/79): 1.5% (1/68) ­after lobec­to­my, and 20% (2/10) ­after pneu­mo­nec­to­my (p=not sig­nif­i­cant). Overall sur­vi­val at 5 years was 39.5%.
Conclusions. Preoperative car­di­o­pul­mo­nary ­risk for vet­e­rans ­with bron­cho­gen­ic can­cer is accept­able and ­lung resec­tion can be per­formed ­with ­good out­comes in ­this dis­tinct ­patient pop­u­la­tion.

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