Does lobectomy for lung cancer in patients with chronic obstructive pulmonary disease affect lung function? A multicenter national study

Objective: The purpose of this study was to evaluate the effect of lobectomy onpulmonary function in patients with chronic obstructive pulmonary disease.Methods: One hundred thirty-seven patients were analyzed; 49 had normal pulmonaryfunction tests, and 88 had chronic obstructive pulmonary disease. Differentfunctional parameter groups were identified: obstructive (forced expiratory volumein 1 second [FEV1], forced expiratory volume in 1 second/forced vital capacity[FEV1/FVC], and chronic obstructive pulmonary disease index), hyperinflation(residual volume and functional residual capacity), and diffusion (transfer factor ofthe lung for carbon monoxide). Also, the ratio between observed and predictedpostoperative FEV1 was calculated.Results: In patients with preoperative FEV1 greater than 80% of predicted, postoperativeFEV1/FVC slightly but not significantly decreased, and postoperative FEV1significantly decreased. In patients with preoperative FEV1 less than 65%, postoperativeFEV1 and FEV1/FVC significantly increased. In patients with preoperativeFEV1/FVC greater than 70%, postoperative FEV1 and FEV1/FVC significantlydecreased. In patients with preoperative FEV1/FVC less than 70%, postoperativeFEV1/FVC increased, and FEV1 remained unchanged. In patients with a chronicobstructive pulmonary disease index greater than 1.5, postoperative FEV1 andFEV1/FVC significantly decreased, whereas in patients with a chronic obstructivepulmonary disease index less than 1.5, postoperative FEV1/FVC significantly increasedand FEV1 remained unchanged. In patients with residual volume andfunctional residual capacity greater than 115% and transfer factor of the lung forcarbon monoxide less than 80% of predicted, postoperative FEV1 diminished less(not significant) compared with patients who had residual volume and functionalresidual capacity less than 115% (P .0001). Observed postoperative/predictedpostoperative FEV1 was higher if FEV1/FVC was less than 55% (1.46), if FEV1 wasless than 80% of predicted (1.21), or if the chronic obstructive pulmonary diseaseindex was less than 1.5 (1.17).Conclusions: Patients with mild to severe chronic obstructive pulmonary diseasecould have a better late preservation of pulmonary function after lobectomy thanhealthy patients.