Quality of life after tailored combined surgery for stage I non–small-cell lung cancer and severe emphysema

Abstract

Background. We analyzed the early and long-term quality of life changes occurring in 16 patients undergoing tailored combined surgery for stage I non-small-cell lung cancer (NSCLC) and severe emphysema.Methods. Mean age was 65 ؎ 5 years. All patients had severe emphysema with severely impaired respiratory function and quality of life. Tumor resection was performed with sole lung volume reduction (LVR) in 5 patients, separate wedge resection in 3 patients, segmentectomy in 2 patients, and lobectomy in 6 patients. A bilateral LVR was performed in 5 patients. Quality of life was assessed at baseline and every 6 months postoperatively by the Short-form 36 (SF-36) item questionnaire.Results. Mean follow-up was 44 ؎ 21 months. All tumors were pathologic stage I. There was no hospital mortality nor major morbidity. Significant improvements

Quality of life following thoracotomy for lung cancer

“…Pompeo et al 16 analyzed QoL in 16 patients undergoing tailored combined surgery for stage I lung cancer and severe emphysema using the SF-36 questionnaire. Significant improvements occurred for up 36 months in the general health domain and for 24 months in physical functioning, role physical and general health SF-36 domains.…”

Lung Transplantation and Lung Volume Reduction Surgery versus Transplantation in Chronic Obstructive Pulmonary Disease

“…Patients with lung cancer are not candidates for lung transplantation; LVRS, however, has been performed successfully in patients with limited-stage non-small cell lung cancer along with cancer resection. These combined procedures have allowed for a potentially curative resection in patients who may have been limited by poor lung function in the traditional approach, and should be considered in selected individuals (21)(22)(23)(24)(25)(26)(27)(28). Other medical as well psychological and social factors may interfere with the patient's ability to maintain the consistent immunosuppressive regimen and medical follow-up that are crucial after transplantation, but may not be barriers for LVRS.…”

“…The transplantation procedure is generally of longer duration, with a more frequent requirement for cardiopulmonary bypass (31,33,(35)(36)(37). For patients who receive single-lung transplantation (SLT), as well as those aged less than 60 years who receive bilateral lung transplant (BLT), the mortality is about 6% at 30 days and 9-15% at 90 days post-transplantation, compared with 2.2% at 30 days and 5.2% at 90 days post-LVRS in non-high-risk patients (high-risk patients are those with FEV 1 < 20% predicted and either homogeneous disease on HRCT or DL CO < 20% predicted) (19,28). Patients aged 60 years and older have even higher 30-day mortality (28).…”

Radiographic Evaluation of the Potential Lung Volume Reduction Surgery Candidate

“…By accepted criteria for resectability of non-small cell lung cancer, LVRS candidates are at high risk and/or have lung function impairment considered prohibitive for surgical therapy. There is a limited experience of combining LVRS procedures and surgical resection, based on the premise that the LVRS component of the operation should result in an improvement in lung function (33,35). Early clinical results suggest that highly selected patients tolerate the combined procedure well and have an early course that is not different than that of patients undergoing either procedure alone.…”