Lung Volume Reduction Surgery Alters Management of Pulmonary Nodules in Patients With Severe COPD: Outcome
The postoperative mortality rate was 0% in the study and control groups. In addition, only two patients in the study group developed evidence of significant morbidity. Patient 1 developed right middle lobe pneumonia and patient 5 had a prolonged air leak requiring continued chest tube use. In the control group, three patients developed postoperative complications. One patient had a wound infection necessitating surgical debridement and IV antibiotics and two other patients had prolonged air leaks (one with the additional complication of an infection at the site of the chest tube that required IV antibiotics). During follow-up, the mortality rate has remained 0% in both groups. Only LVRS patient 4 has required hospitalization, approximately 4 months after surgery, for community-acquired pneumonia.
Figure 2 illustrates the FEV: (percent predicted) and FVC (percent predicted) before and at least 3 months after surgery in the study group. A rise in FEVj is noted in all individuals. The mean rise in FEVj was 47% while the increase in FVC was 25%. Figure 3 illustrates the BDI and TDI in all subjects. There was significant preoperative breathlessness in most study patients, consistent with the presence of severe chronic airflow limitation. Importantly, all patients undergoing simultaneous LVRS and nodule resection noted improved breathlessness after surgery, as indicated by a positive TDI in all subjects. cialis professional
Follow-up time ranged from 8 to 20 months (mean, 13 months). During this period of time, no patient with proved bronchogenic carcinoma has demonstrated evidence of recurrence.
We demonstrate the feasibility of combined LVRS and resection of solitary pulmonary nodules in 11 patients with very severe COPD. These individuals, who were considered to be at prohibitive risk using standard preoperative criteria, demonstrated no increase in hospital length of stay or hospital complications after undergoing simultaneous surgical excision of the pulmonary lesion and lung volume reduction. Furthermore, pulmonary function and dyspnea improved in all patients after surgery. Surgical criteria for operability of solitary pulmonary nodules must be updated in the era of LVRS.
Figure 2. Comparison of FEVX and FVC as a percent of predicted values before (preoperative) and after surgery (postoperative) in 11 patients undergoing simultaneous LVRS and excision of a pulmonary nodule.
Figure 3. BDI plotted vs TDI in 11 patients undergoing simultaneous LVRS and excision of a pulmonary nodule. A positive value on the TDI axis indicates a lessening of dyspnea after LVRS. The higher the value, the greater the improvement in the level of dyspnea. On the BDI axis, a value of zero represents the most severe level of dyspnea. See text for greater detail. Asterisk=no BDI for this patient.