Chest
Original ResearchCancerChanges in Lung Function Parameters After Wedge Resections: A Prospective Evaluation of Patients Undergoing Metastasectomy
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:
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Funding/Support: The authors have reported to CHEST that no funding was received for this study.
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