Surgical Treatment for Lung Cancer with COPD Based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD)

 

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Abstract

Objective: The surgical indications for non-small cell carcinoma (NSCLC) with chronic obstructive pulmonary disease (COPD) are not well known. A classification of severity in COPD has been newly recommended by the US National Heart, Lung, and Blood Institute (NHLBI) and the World Health Organization (WHO). Therefore, based on this new system of classification, we review here a series of NSCLC patients with COPD who underwent lung resection at our hospital and attempt to identify the survival and morbidity of such patients. Methods: We retrospectively reviewed the patients with NSCLC treated at our hospital between January 1994 and December 2002. Among these 640 patients, a curative approach was attempted in 50 with COPD (31 lobectomies, 11 segmentectomies, 8 bilobectomies). The patients were consequently divided into two groups (moderate group and severe group) according to the Global Iinitiative for Chronic Obstructive Lung disease (GOLD). Lung function was evaluated by FEV1 and FVC, and the survival rates were analyzed at 5 years. Postoperative morbidity was also compared between the two groups. Results: FEV1 was 1.527 ± 0.311 L in the moderate group compared with 1.025 ± 0.224 L in the severe group (p < 0.001). Postoperative decrease in FEV1 was lower compared to the predicted data of patients who underwent surgery for NSCLC with COPD. Postoperative pulmonary support such as mechanical ventilation or tracheotomy were necessary more frequently in the severe group. A significant difference was observed between the two groups in respiratory support (p = 0.0102). Overall 5-year survival rate for NSCLC with COPD was 73.9 %, although there was no statistically significant difference between the moderate and severe groups in terms of survival. Lobectomy and segmentectomy show a remarkable advantage for the patients with bilobectomy, although this difference was not statistically significant. On the other hand, gender, degree of COPD, and histological type were shown to be not significant factors. Survival rate of these NSCLC patients with COPD were demonstrated to be comparable to those of the NSCLC patients without COPD in stages I and II. Conclusion: Stringent selection of candidates among NSCLC patients with a severe grade of COPD based on GOLD could be an acceptable and valuable approach compared to conventional patients without COPD, although NSCLC with severe COPD patients more frequently needed respiratory support.

References

• 1 Thomas P, Doddoli C, Yena S, Thirion X, Sebag F, Fuentes P, Giudicelli R. VATS is adequate oncological operation for stage I non-small cell lung cancer.  Eur J Cardiothorac Surg. 2002;  21 1094-1099
  CrossrefPubMedGoogle Scholar
• 2 Frank A P, Robert J K, Peter F F, Rodney J L. Unsuspected lung cancer found in workup for lung reduction operation.  Ann Thorac Surg. 1996;  61 174-176
  CrossrefPubMedGoogle Scholar
• 3 Iwasaki A, Yoshinaga Y, Kawahara K, Shirakusa T. Evaluation of lung volume reduction surgery (LVRS) based on long-term survival rate analysis.  Thorac Cardiovasc Surg. 2003;  51 277-282
  Article in Thieme ConnectPubMedGoogle Scholar
• 4 Carretta A, Zannini P, Puglisi A, Chiesa G, Vanzulli A, Bianchi A, Fumagalli A, Bianco S. Improvement of pulmonary function after lobectomy for non-small cell lung cancer in emphysematous patients.  Eur J Cardiothorac Surg. 1999;  15 602-607
  CrossrefPubMedGoogle Scholar
• 5 Pauels R A, Buist S, Calverley P MA, Jenkins C R, Hurd S S. Global strategy for diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO global initiative for chronic obstructive lung disease (GOLD) workshop summary.  Am J Respir Crit Care Med. 2001;  163 1256-1276
  CrossrefPubMedGoogle Scholar
• 6 Juhl B, Frost N. A comparison between measured and calculated changes in the lung functions after operation for pulmonary cancer.  Acta Anaesth Scand. 1975;  57 39-45
  PubMedGoogle Scholar
• 7 Gass G D, Olsen G N. Preoperative pulmonary function testing to predict postoperative morbidity and mortality.  Chest. 1986;  89 127-135
  PubMedGoogle Scholar
• 8 Yoshinaga Y, Iwasaki A, Kawahara K, Shirakusa T. Lung volume reduction surgery results in pulmonary emphysema.  Jpn J Thorac Cardiovasc Surg. 1999;  47 445-451
  PubMedGoogle Scholar
• 9 Bellemare F, Cordeau M P, Couture J, Lafontaine E, Leblanc P, Passerini L. Effects of emphysema and lung volume reduction surgery on transdiaphragmatic pressure and diaphragm length.  Chest. 2002;  121 1898-1910
  CrossrefPubMedGoogle Scholar
• 10 Koizumi K, Haraguchi S, Akiyama H, Hirata T, Hirai K, Mikami I, Tanaka S. Comparison of changes in hemodynamics between unilateral and bilateral lung volume reduction for pulmonary emphysema.  Ann Thorac Cardiovasc Surg. 2001;  7 266-272
  PubMedGoogle Scholar
• 11 Ambrogi V, Pompeo G, Matteucci G, Mineo T C. Combined surgery for emphysema and lung cancer.  Eur J Cardiothorac Surg. 2000;  18 372-374
  CrossrefPubMedGoogle Scholar
• 12 Arroliga A, Buzaid A, Matthay R. Which patients can safely undergo lung resection?.  J Respir Dis. 1991;  12 1080-1086
  PubMedGoogle Scholar
• 13 Sekine Y, Behnia M, Fujisawa T. Impact of COPD on pulmonary complications and on long-term survival of patients undergoing surgery for NSCLC.  Lung Cancer. 2002;  37 95-101
  CrossrefPubMedGoogle Scholar
• 14 Edwards J G, Duthie D J, Waller D A. Lobar volume reduction surgery: a method of increasing the lung cancer resection rate in patients with emphysema.  Thorax. 2001;  56 791-795
  CrossrefPubMedGoogle Scholar
• 15 Kearney D J, Lee T H, Reilly J J, DeCamp M M, Sugarbaker D J. Assessment of operative risk in patients undergoing lung resection. Importance of predicted pulmonary function.  Chest. 1994;  105 753-759
  CrossrefPubMedGoogle Scholar
• 16 Stein M, Koota G M, Simon M, Frank H A. Pulmonary evaluation of surgical patients.  JAMA. 1962;  181 765-770
  PubMedGoogle Scholar
• 17 Kearney D J, Lee T H, Reilly J J, Decamp M M, Sugarbaker D J. Assessment of operative risk in patients undergoing lung resection: importance of predicted pulmonary function.  Chest. 1994;  105 753-759
  CrossrefPubMedGoogle Scholar
• 18 Datta D, Lahiri B. Preoperative evaluation of patients undergoing lung resection surgery.  Chest. 2003;  123 2096-2103
  CrossrefPubMedGoogle Scholar
• 19 Haniuda M, Kubo K, Fujimoto K, Aoki T, Yamanda T, Amano J. Different effects of lung volume reduction surgery and lobectomy on pulmonary circulation.  Ann Surg. 2000;  231 119-125
  CrossrefPubMedGoogle Scholar

Dr. Akinori Iwasaki

Second Department of Surgery
School of Medicine
Fukuoka University

45-1, 7-chome Nanakuma, Jonan-ku

Fukuoka 814-0180

Japan

Phone: + 81928011011

Fax: + 81 9 28 61 82 71

Email: akinori@fukuoka-u.ac.jp