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Chirurgie 30. April 2013

Impact of resection techniques on postoperative lung function parameters in pulmonary metastasectomy

Background: Pulmonary metastasectomy with curative intent is nowadays a common practice in thoracic surgery. The impact of metastasectomy on respiratory function has become a relevant factor in the treatment algorithm of these patients. However, no sufficient data on the loss of lung function following pulmonary metastasectomy is available to date.

Methods: A prospective single center study was designed to determine changes in lung function parameters in patients undergoing metastasectomy. Forty-five consecutive patients were included in the study. In 19 patients, metastases were removed by enucleation (laser = 10; electrocautery = 9), in 19 patients by wedge resection, and 7 patients received a lobectomy in order to achieve clear resection margins. Lung function testing was obtained from all patients preoperatively and 3 months after hospital discharge.

Results: A significant decrease in FEV1 and VC was found when comparing enucleation/wedge/lobectomy patients (FEV1: 3.4 ± 0.7, 7.6 ± 1.5, 14.2 ± 3.0; VC: 2.4 ± 1.6, 4.7 ± 1.6, 16.9 ± 2.9; respectively). However, no differences were found regarding the loss of FEV1 per resected nodule between laser and electrocautery enucleations. These findings were confirmed by a volumetric analysis of the resected tissue and did not correlate with size of metastases as determined by preoperative CT evaluations.

Conclusions: The surgical resection of pulmonary metastases is associated with a detectable but mild loss of lung function. Lung parenchyma sparing resection methods—e.g. electrocautery or laser enucleations—should be preferred over less tissue-sparing techniques.

K. Hoetzenecker, T. Schweiger, C. Nikolowsky, L. Lehmann, F. Gittler, H. J. Ankersmit, W. Klepetko, G. Lang, European Surgery 2/2013

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