Early and long-term results of lung resection for non-small-cell lung cancer in patients with severe ventilatory impairment

Objective: To study clinical characteristics, surgical treatment modalities, early and tong-term outcome of patients with severe ventilatory impairment undergoing lung resection for NSCLC. Methods: We performed a retrospective review of clinical records of all. patients with severe chronic ventilatory impairment (FEV1 and/or FVC <= 50% of predicted values) operated on for NSCLC in a 21-year period (1983-2003). Results: One hundred and six patients were operated on. Mean FEV1 and FVC were 40% (range 23-50%) and 69% (17-117%), respectively. An obstructive pattern was observed in 87 cases (82%). Extent of maximal exeresis was based on the assessment of predicted post-operative FEV1 (ppoFEV1). Major resections were contraindicated if ppoFEV1 was tower than 30%. Sixteen pneumonectomies, 73 lobectomies and 17 sublobar resections were carried out. Pathologic stages were 1, 11, IIIA and IIIB in 58, 26, 18 and 4 cases, respectively. Resection was complete in 104 patients. Operative mortality and morbidity were 8.5% (n = 9) and 70% (n = 74), respectively. Twenty-two patients needed prolonged (> 48 h) mechanical ventilation. Overall mean ppoFEV1 toss was 9.1% (0-34%). If ppoFEV1 loss was > 15%, the morbidity rate was 100%. Mean PaCO2 and ppoFEV1 loss were higher among patients who died (41 mmHg versus 37 mmHg, P = 0.02 and 13.2% versus 8.5%, P = 0.025, respectively) as compared with operative survivors. Among patients with PaCO2 > 39 mmHg and ppoFEV1 loss > 15% (n = 9), mortality rate was 33%. Overall 1-year and 5-year survival rates were 82 and 33%, respectively. Respiratory failure was the cause of late death in 2 patients. Among patients available at follow-up (n = 85), respiratory function was considered subjectively improved, stable and worsened in 6 (7%), 62 (73%) and 17 (20%) cases, respectively. Eleven patients needed continuous oxygen therapy. Conclusions: Lung resection should not be denied a priori in patients with severe ventilatory impairment. Evaluation of predicted post-operative function often allows major resections, which are functionally economic, at the price of a high operative morbidity. Operative mortality, long-term survival and respiratory function are acceptable in the absence of a valid therapeutic alternative. (c) 2005 Elsevier B.V. All rights reserved.