Pulmonary resection in patients with a predicted value of FEV_1.0<500 ml in the contralateral lung

Abstract

A preoperative value of forced expiratory volume in one second that was less than 500 ml in the contralateral lung (FEV_1c <500 ml) has been suggested to be a lower limit value for pulmonary resection. To extend surgical treatment to the patients with FEV_1c <500 ml, we carried out 16 lobectomies and 3 segmental resections and compared the morbidity of postoperative pulmonary complications and mortality with those in patients with FEV_1c 500 ml. FEV_1c was calculated by the equation; FEV_1c= (preoperative FEV_1.0) × (proportion of pulmonary perfusion in the contralateral lung) / (body surface area). Seventeen patients discharged in very good condition. However, there were lung complications in 14 patients : atelectasis (n= 8), air leak for more than three days (n=4), bronchial asthma (n=3) -Two patients died of interstitial pneumonitis or pneumonia following bronchial fistula. The morbidity of postoperative atelectasis and mortality of patients with FEV_1c <500 ml were 42.1% and 10.5%, respectively, they were significantly higher than those of patients with FEV_1c ≥_500 ml (p <0.05). Patients with atelectasis had values significantly lower FEV_1.0%, higher %TLC, and higher PaCO₂ than those without atelectasis (p<0.05). In conclusion, we could perform pulmonary resection to patients with FEV_1c <500 ml despite the higher morbidity of atelectasis and mortality. Preoperative values of FEV_1.0%, %TLC, and PaCO₂ are predictive markers for postoperative atelectasis in patients with FEV_1c <500ml.