Triple primary lung cancers with impaired pulmonary function ; a case report

Abstract

Recently we operated on a patient with triple primary lung cancers : adenocarcinoma in left S¹⁺²a and squamous cell carcinomas at the ostium of left B³ and at the spur between right B² and B³. The patient also had impaired pulmonary function, VC 2.1l (63%), FEV _1.0 0.7l (40 %), RV 4.6l (74%), VO₂max 408 ml/min and VO₂/V_E 20 ml/l. On the basis of these results bilateral upper lobectomies were judged to be impossible. Upper left lobectomy and limited radiation to the right lung were planned. After the operation marked dyspnea on light exercise continued and his ECOG performance status scale was grade four for more than half a year. Limited radiation was applied about 12 months after surgery, but his respiratory function deteriorated and he died.
There are many studies correlating preoperative respiratory function and postoperative complications, but there has been no precise description of the limit of lung resection. We conclude that this patient illustrates the limit of pulmonary resection.