Thoracoscopic Partial Lung Resection in Patients With Severe Chronic Obstructive Pulmonary Disease

Abstract

Objective: To determine if patients with severe chronic obstructive pulmonary disease can tolerate thoracoscopic partial lung resection. Design: Patients with non—small-cell lung cancers were selected from 583 cases undergoing laser treatment. The parameters studied included sex, age, tumor size, spirometry (forced vital capacity, forced expiratory volume in 1 second), operating time, operative mortality rate, postoperative ventilatory time, and length of hospital stay. The follow-up period varied from 4 to 30 months. Setting: A private community hospital with nationwide referrals. Patients: Nine consecutive patients (five men, four women) were found to have lung cancer before (four patients) or at (five patients) surgery. Their mean (±SD) age was 71.2±3.8 years; tumor size, 3.3±1.6 cm; forced vital capacity, 2.04±0.50 L (49.7%±10.2%); and forced expiratory volume in 1 second, 0.66±0.11 L (22.2%±5.5%). Interventions: With patients under general anesthesia with one-lung ventilation, the tumor was resected and coexisting diffuse bullae were treated by a contact neodymium:YAG laser. Four patients received adjuvant therapies: chemotherapy, one; radiation and chemotherapy, one; radiation, one; and brachytherapy, one. Main Outcomes: All patients tolerated surgery; there were no deaths. Mean (±SD) operating time was 4.9±1.4 hours; postoperative ventilatory time, 10.3±6.8 hours; and length of hospital stay, 15.2±13.2 days. Results: One patient died of disease progression 4 months after surgery. There was one local recurrence and one distant metastasis. Four patients remained free of tumors. Conclusion: Patients with severe chronic obstructive pulmonary disease can tolerate thoracoscopic partial lung resection but an effort should be made to reduce local recurrence. (Arch Surg. 1994;129:940-944)