Chest
Volume 141, Issue 6, June 2012, Pages 1482-1489
Journal home page for Chest

Original Research
Cancer
Changes in Lung Function Parameters After Wedge Resections: A Prospective Evaluation of Patients Undergoing Metastasectomy

https://doi.org/10.1378/chest.11-1566Get rights and content

Background

Pulmonary metastasectomy with lung-sparing local excisions is a widely accepted method of treating 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 of lung for carbon monoxide (Dlco), and blood gases and potential confounding factors were measured prior to, immediately following, and 3 months after the procedure and were analyzed.

Results

Seventy-seven patients with a median age of 61.3 years underwent up to 22 wedge resections. The mean lung function losses were FVC (−7.5%), total lung capacity (TLC) (−7.9%), FEV1 (−9.2%), and Dlco (−8.8%), and all were statistically significant (P < .001). The lung function losses also differed 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 thoracotomy.

Section snippets

Materials and Methods

From April 2008 to April 2010, patients who were scheduled to have pulmonary metastasectomy were asked to take part in this prospective evaluation. The inclusion criteria were proven primary malignancy, suspected lung metastases, sufficient pulmonary function to tolerate the planned resection, no contraindication due to concomitant disease, scheduled operation, and written consent. The hospital review board approved this study protocol (but did not generate an approval number). All patients

Results

Altogether, 117 patients completed the study protocol. Forty patients had an anatomic resection or had an anatomic resection combined with wedge resections and were excluded from this evaluation. Seventy-seven patients who underwent metastasectomy had only wedge resections and were included in the analysis. The demographics of the 77 patients are presented in Table 1. The follow-up lung function testing took place at a median of 3.34 months (SD 1.50; range, 2.10-11.28 months) after the last

Discussion

Parenchyma-sparing pulmonary metastasectomy is now a standard procedure in thoracic surgery units and is performed frequently and routinely. Any number of wedge resections, up to > 20, can now be performed safely in carefully selected patients. The functional selection criterion is sufficient pulmonary function to tolerate resection. Depending on their extent, pulmonary resections can lead to permanent reductions in pulmonary function.6 The reductions in FVC, TLC, and FEV1 after lobectomy were

Conclusions

In this prospective observational study of patients undergoing pulmonary metastasectomy, we first described a formula to predict postoperative lung function after metastasectomy. We then showed that every additional wedge excision reduces spirometry values by roughly 0.6%. We further demonstrated that wedge resections via thoracotomy and a bilateral intervention can significantly reduce spirometry parameters and that chemotherapy significantly reduces diffusing capacity, even at 3 months after

Acknowledgments

Author contributions: Dr Welter: contributed to the concept of the study, data acquisition and analysis, and drafting of the manuscript.

Dr Cheufou: contributed to the concept of the study, data acquisition and analysis, and drafting of the manuscript.

Dr Sommerwerck: contributed to the analysis and interpretation of the data and critical revision of the manuscript.

Dr Maletzki: contributed to the statistical evaluation, data interpretation, and reviewed and approved the manuscript.

Dr Stamatis:

References (24)

  • F Leo et al.

    Respiratory function changes after chemotherapy: an additional risk for postoperative respiratory complications?

    Ann Thorac Sur

    (2004)
  • GN Olsen et al.

    Pulmonary function evaluation of the lung resection candidate: a prospective study

    Am Rev Respir Dis

    (1975)
  • Cited by (18)

    • Alternatives to Surgery for Early-Stage Non–Small Cell Lung Cancer: Thermal Ablation

      2020, Clinics in Chest Medicine
      Citation Excerpt :

      In contrast, even sublobar surgical resection has been associated with a measurable decline in pulmonary function. One study showed 7% to 9% decreases in total lung capacity (TLC), FEV1, FVC, and DLCO after wedge resection, with each additional resection associated with a linear functional decline.4 Likewise, stereotactic body radiation therapy (SBRT) is also associated with demonstrable decreases in TLC, FEV1, FVC, and DLCO.5,6

    • Agreement between computed tomography and pathologic nodule counts in colorectal lung metastases

      2016, Annals of Thoracic Surgery
      Citation Excerpt :

      The indication for resection of all nodules found intraoperatively can be justified by the presence of macroscopic alterations of the lung because the surgeon tends to extirpate all observed lesions, achieve a complete resection, and facilitate radiologic follow-up [25]. It should be considered that every resection could increase morbidity and reduce lung function [26]. The database does not include information about radiologists expertise nor modalities imaging algorithms [8, 27].

    • Image-guided lung tumor ablation: Principle, technique, and current status

      2013, Journal of the Chinese Medical Association
      Citation Excerpt :

      However, only 15% of lung cancer patients have localized disease for which surgery is a treatment of option. This is further complicated by a decrease in lung function after surgery, which results in a mean change in forced expiratory volume in 1 second (FEV1) in 11–25% of patients after lobectomy, in 11–13% of patients after segmentectomy, and in 9% of patients after wedge resection.5,6 A proportion of individuals with low pulmonary reserve do not meet the criteria for a lung operation, as defined by the American College of Surgeons Oncology Group/National Institutes of Health (NIH) Inoperability Criteria for Lung Surgery.7

    View all citing articles on Scopus

    Funding/Support: The authors have reported to CHEST that no funding was received for this study.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

    View full text