From January 1995 to June 1996, 467 patients were evaluated for LVRS at the University of Michigan Medical Center. Of these, 113 were deemed appropriate for surgery and 75 have undergone either unilateral (16 patients) or bilateral (59 patients) LVRS. Eleven patients were noted to have single pulmonary nodules, defined as a nodule measuring 2 cm, discovered preoperatively during routine radiographic imaging (n=10) or at the time of surgery (n=l). These patients underwent simultaneous LVRS and resection of the nodule. Patient characteristics and preoperative lung function for both the study and control groups are listed in Table 1. There was a significant difference in FEVX between the study and control groups (26.18±2.49% predicted compared with 81.36±6.07% predicted) (p=0.000001). A similar difference was seen in FVC between study patients (65.27±5.17% predicted) and control patients (92.18±5.53% predicted) (p=0.0002) (data not shown). Preoperative 6-min walk distance in the study group was 540.00±99.63 feet with all experiencing significant desaturation (lowest oxygen saturation, 88.6± 1.24%).
Despite marked differences in preoperative pulmonary function, the mean length of stay did not differ significantly between the study and the control groups (7.55±1.10 days compared with 8.81±1.56 days) (Table 2). The characteristics and histologic diagnoses of the nodules resected in the study group patients are listed in Table 3. Of the two nodules in the study group with radiographic evidence of calcification, the pattern of calcification was consistent with a benign process in one. In the control group, the identity of the resected lesions included one carcinoid tumor, four squamous cell carcinomas, five adenocarcinomas, and one small cell carcinoma. canadian-familypharmacy.com

Four of the 11 patients required wedge resection of lung remote from the areas involved in LVRS in order to resect the nodules. Despite the removal of potentially functioning pulmonary parenchyma proximate to the nodules, these four patients still demonstrated significant improvement in postoperative pulmonaiy function. Figure 1 illustrates the preoperative HRCT of study group patient 2, demonstrating apical predominant bullous emphysema and the presence of a pulmonary nodule in the right upper lobe.

Table 1—Patient Characteristics

FEVi, L RV, L Deo, mL/mm Hg PaC02, Pa02,
Patient/Age, yr/Sex (% Predicted) (% Predicted) (% Predicted) mm Hg mm Hg
Study group
1/52/M 0.72 9.62 11.56 41 69
2/71/M 1.10 5.55 10.76 36 67
3/55/F 0.51 6.75 8.87 33 77
4/72/M 0.82 5.61 8.79 39 70
5/53/F 0.32 4.48 10.86 49 54
6/67/M 1.19 4.57 13.15 34 72
7/66/F 0.53 6.52 6.56 50 68
8/54/M 0.98 7.25 Not done 42 73
9/55/F 1.01 4.06 13.41 38 65
10/56/F 0.63 4.67 15.94 40 71
11/62/M 0.53 9.04 Not done 39 77
6M 0.76±0.08 6.19±0.53 11.10±0.89 40.09±1.56 69.36±1.82
60.27±2.17 5F (26.18±2.49) (313.27±25.57) (45.78±4.31)
Control group
60.27±2.17 6M 2.33±0.17 NA NA NA NA
5F (81.36±6.07)

Table 2—Details of Surgical Intervention in Study and Control Groups

Patient Extent of Surgery Length of Stay, d
Study group
1 MST, RLL LVRS 12
2 (B) apical LVRS 7
3 (B) apical LVRS 6
4 MST, RLL LVRS 6
5 (B) apical LVRS 6
6 MST, LLL LVRS 16
7 (B) apical LVRS 4
8 (B) apical LVRS 5
9 (B) apical LVRS 4
10 MST, RLL LVRS 9
11 (B) apical LVRS 8
Mean 7.55±1.10
Control group
Mean 8 RUL, 3 LUL, 1 RML, 1 RLLf 8.81±1.56

Table 3—Nodule Characteristics

Patient RadiographicallyApparent Size, cm Calcification Location Histologic Diagnosis
1 Yes 2.5 Yes RLL Granuloma
2 Yes 1.8 No RUL Large cell cancer
3 Yes 1.0 No LLL Hamartoma
4 Yes 2.4 No RUL Squamous cell cancer
5 Yes 0.5 No RUL Granuloma
6 No NA NA LUL Granuloma
7 Yes 1.5 No LUL Hamartoma
8 Yes 1.0 Yes RUL Granuloma
9 Yes 0.5 No LUL Granuloma
10 Yes 1.5 No RLL Adenocarcinoma
11 Yes 1.0 No RLL Anthracotic lymph node

Figure 1. Preoperative HRCT of patient 2 prior to LVRS and wedge resection of pulmonary nodule demonstrating upper lobe predominant bullous emphysema and presence of a noncalcified right upper lobe pulmonary nodule (top) and relative sparing of the parenchyma of the bilateral lower lobes (bottom).

Figure 1. Preoperative HRCT of patient 2 prior to LVRS and wedge resection of pulmonary nodule demonstrating upper lobe predominant bullous emphysema and presence of a noncalcified right upper lobe pulmonary nodule (top) and relative sparing of the parenchyma of the bilateral lower lobes (bottom).

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