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


lingua: Inglese

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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