We emphasize that combined LVRS and wedge resection of pulmonary nodules is not appropriate for all patients with severe COPD and an indeterminate pulmonary nodule. Our results are applicable only to a highly select group of patients who underwent surgery primarily for emphysema, not the lung nodule. Our patients were selected for LVRS on the basis of severe airflow obstruction, hyperinflation, and the presence of identifiable hypoperfused or severely emphysematous portions of the lung, ie, “target zones.” We believe that our successful results are, at least in part, due to the improved pulmonary function brought about by LVRS, and do not claim that successful pulmonary resection can be accomplished in all patients with severe COPD. The pulmonary nodules in our patients were identified as part of their evaluation for LVRS. However, based on our data, we believe it is feasible to evaluate patients with severe airflow limitation in the clinical scenario of a single pulmonary nodule with hopes of performing this dual procedure. Furthermore, our results indicate that the incidental discovery of a suspicious lung nodule during evaluation for LVRS need not be a contraindication to surgical therapy for emphysema. canadian neightbor pharmacy

In summary, our study demonstrates the feasibility of resecting localized pulmonary lesions in individuals with very severe COPD. Using an aggressive, multidisciplinary approach, including pulmonary rehabilitation, in a select group of patients, the hospital course was not significantly different from a group of low-risk individuals undergoing standard lobectomy for bronchogenic carcinoma. In addition, the improved lung function seen with simultaneous lung volume reduction is a clear advantage to alternative treatment modalities. Long-term follow-up is needed to better define the optimal role of simultaneous lung cancer resection and volume reduction in patients with advanced COPD.