Lung Volume Reduction Surgery Alters Management of Pulmonary Nodules in Patients With Severe COPD: Surgical Techniques
Surgical techniques for study patients included either median sternotomy with bilateral apical lung volume reduction utilizing a linear stapler buttressed with strips of bovine pericardium or unilateral lower lobe reduction via a muscle-sparing thoracotomy. The location and volume of resected tissue were guided by findings from HRCT and SPECT scanning that delineated those areas involved with severe emphysematous change receiving minimal, if any, perfusion. All nodules not contained within the parenchyma removed as a function of lung volume reduction were excised via minimal wedge resection. All patients undergoing wedge resection of carcinoma had a grossly complete resection of the tumor. Control patients had a standard lobectomy or bilobectomy via muscle-sparing thoracotomy. Pulmonary nodules and resected pulmonary parenchyma were submitted to the pathology department for permanent fixation with appropriate fungal staining techniques as indicated. While hospitalized, patients were followed up closely by both the pulmonary and thoracic surgery services.
Preoperatively, pulmonary function data, exercise testing, radiographic imaging, and assessment of dyspnea were obtained as noted in study patients. Control subjects underwent spirometric measurement only. Spirometric data were collected on all patients undergoing simultaneous LVRS and resection of suspected bronchogenic carcinoma at least 3 months postoperatively. Perioperatively, all minor and major complications, mortality, and length of hospital stay were recorded for both groups. All data are expressed as mean±SE.
Comparison between study and control groups was made utilizing an unpaired, two-tailed Student’s t test. A p value <0.05 was considered statistically significant.