Lung Volume Reduction Surgery Alters Management of Pulmonary Nodules in Patients With Severe COPD: Conclusion
While much of the improvement in lung function expected after LVRS appears gradually over the first several months after surgery, there are recent data suggesting improved static elastic recoil pressure in the immediate postoperative period which could lead to early improvement in airflow characteristics and, therefore, could have simplified perioperative management. Preliminary reports have suggested the possibility of combined lung volume reduction and cancer resection, although limited follow-up information was provided. To our knowledge, our series is one of the first to report impressive early results after LVRS and simultaneous resection of a suspected lung cancer and is the first to compare such results against those of a control group with essentially normal pulmonary function who had standard surgical procedure for resection of a known bronchogenic carcinoma. Recently reported was a series of 51 patients undergoing LVRS and resection of a suspicious pulmonary nodule. Eleven of these patients were demonstrated to have non-small cell cancer and 40 had benign lesions. At the time the article was written, none of the patients with bronchogenic cancer had demonstrated evidence of recurrence and the postoperative complication rate was similar to that in our own series. canadian health & care mall
Despite our favorable short-term results, in terms of morbidity and mortality, the potential disadvantages of limited surgical resection for lung cancer remain an important drawback to the technique. While some reports comparing limited resection via segmentectomy vs lobectomy have demonstrated adequate postoperative morbidity and mortality with no significant difference in survival rates, a controlled study has confirmed a distinct increase in local recurrence and overall death rate (75% and 30%, respectively) with limited resection (segmentectomy or wedge) compared to lobectomy. Although not subjected to a prospective comparison, limited resection appears to offer a survival advantage when compared to radiation therapy in stage I non-small cell lung cancer. In addition, LVRS results in improved pulmonary function, while exter-nal-beam radiation may result in lost pulmonary function. It is possible that the improved pulmonary function attributable to LVRS may improve the ability of patients to tolerate postoperative radiation therapy in an attempt to minimize local recurrence In addition, combined LVRS and resection of a small bronchogenic carcinoma via median sternotomy does not allow a thorough hilar or mediastinal lymph node dissection. Thus, important prognostic information is lost when only a wedge resection is performed.