Lobectomy combined with lung volume reduction for high risk lung cancer PTS with severe emphysema

Purpose: To determine if a combination of lobectomy with lung volume reduction surgery is feasible in patients previously thought inoperable due to severe emphysema. Method: Three patients presenting with lung cancer underwent median sternotomy with formal lobectomy plus additional lung volume reduction. Objective measurements of pulmonary function before and after operation were evaluated. Results: Following a period of preop exercise rehabilitation, all patients underwent median sternotomy, standard lobectomy for lung cancer and volume reduction in one or more additional lobes. All patients were extubated at the end of the procedure, discharged from hospital without major complication, and remain alive and free of cancer recurrence. All patients have experienced significant objective and subjective improvement in their pulmonary status as illustrated in the following table. Pre and postop data are shown in the following table: Age FEV₁% pred O₂w/exercise preop postop pre post 67 29% 44% 3L RA 70 33% 48% RA RA 62 30% 44% IL RA Conclusions: In a highly selected group of patients, standard lung cancer resection plus volume reduction was well tolerated and resulted in improved lung function. Clinical Implications: The combination of volume reduction and lobectomy for patients with severe emphysema and lung cancer may permit resection in patients who otherwise might be considered inoperable or suitable for only a limited excision.