Lung Volume Reduction Surgery Alters Management of Pulmonary Nodules in Patients With Severe COPD
Pulmonary malignancy is the single most common cause of cancer death in both men and women in the United States. Most patients with bronchogenic carcinoma also have coexisting obstructive lung disease. In these individuals, the goal of management is to resect the malignancy without compromising respiratory function. Many investigators have sought to define the risks of pulmonary resection in individuals with suspected malignancy. Recent recommendations have concluded that individuals with predicted postoperative FEV <40% or diffusion of carbon monoxide (Deo) <40% predicted be considered at particularly high risk because of high morbidity and mortality. cialis professional
The resurgence in lung volume reduction surgery (LVRS) has provided an additional surgical approach to improving short-term lung function and exercise capacity in individuals with advanced emphysema after bilateral and unilateral lung volume reduction.
We hypothesized that simultaneous LVRS and wedge resection of a single pulmonary malignancy could be performed successfully in patients who would otherwise be excluded from a potentially curative surgical approach. We report our experience with 11 such patients and demonstrate that combined LVRS and surgical resection of pulmonary nodules is feasible with minimal surgical morbidity and improved postoperative pulmonary function. This combined surgical technique expands the opportunities for surgical resection of suspected, malignant pulmonary nodules.
Materials and Methods
We reviewed the medical records of all patients who underwent LVRS at the University of Michigan Medical Center between January 1, 1995 and May 30, 1996. Both nodules identified during preoperative evaluation for LVRS and those identified at the time of surgery were included. Patients who underwent simultaneous LVRS and resection of the nodular density formed the study group. Study group patients were matched with individuals of the same age and sex who underwent standard lobectomy during the same time period by the same thoracic surgeon (R.W.) and who were selected by a review of the thoracic surgical records.