Changes in lung function parameters after wedge resections: A prospective evaluation of metastasectomy patients
Menée sur 77 patients présentant des métastases pulmonaires, cette étude prospective observationnelle évalue les effets d'une métastasectomie par résection cunéiforme sur la fonction pulmonaire
Background: Pulmonary metastasectomy with lung sparing local excisions is a widely accepted method to treat stage IV malignancies in selected cases. The ability to predict postoperative lung function is an unresolved issue, especially when multiple wedge resections are planned. To help develop a method to predict postoperative lung function after wedge resections, we present this prospective observational study. Methods : A total of 77 patients who underwent one or more wedge resections to remove lung metastases completed the study protocol. Spirometry results, diffusion capacity for carbon monoxide (DLCO) and blood gases and potential confounding factors were measured prior to, immediately following and three months after the procedure and were analyzed.Results: Seventy-seven patients with a median age of 61.3 years underwent one up to 22 wedge resections. The mean lung function losses were FVC (-7.5 %), TLC (-7.9 %), FEV1 (-9.2 %) and DLCO (-8.8 %) and all were statistically significant (p < 0.001). The lung function losses differed also significantly between those having a single and those with more than eight wedge resections. Using regression analysis we found that for every additional wedge resection, there was a reduction in FVC of 30 ml (0.7%), in TLC of 44 ml (0.65%) and in FEV1 of 23 ml (0.58%).Conclusions: Metastasectomy by wedge resection significantly reduces lung function parameters. As a benchmark, we can predict a 0.6% decrease in spirometry values and DLCO for every additional wedge resection and a decrease of approximately 5 % that may be attributed to the thoracotomy.
http://chestjournal.chestpubs.org/content/early/2012/01/18/chest.11-1566.abstract