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a Department of
Medicine, b Department of Thoracic
Surgery, c Royal Victoria Hospital,
Belfast BT12 6BA, UK
Correspondence to: Dr D P Nicholls.
Received 5 June 1998; Returned to authors 20 August 1998; Revised version received 10 November 1998; Accepted for publication 11 December 1998
BACKGROUND
Resection
is the treatment of choice for lung cancer, but may cause impaired
cardiopulmonary function with an adverse effect on quality of life. Few
studies have considered the effects of thoracotomy alone on lung
function, and whether the operation itself can impair subsequent
exercise capacity.
METHODSPatients being
considered for lung resection (n = 106) underwent full static and
dynamic pulmonary function testing which was repeated 3-6 months after
surgery (n = 53).
RESULTSThoracotomy
alone (n = 13) produced a reduction in forced expiratory volume in one
second (FEV1; mean (SE) 2.10 (0.16) versus 1.87 (0.15) l;
p<0.05). Wedge resection (n = 13) produced a non-significant reduction
in total lung capacity (TLC) only. Lobectomy (n = 14) reduced forced
vital capacity (FVC), TLC, and carbon monoxide transfer factor but
exercise capacity was unchanged. Only pneumonectomy (n = 13) reduced
exercise capacity by 28% (P
O2 23.9 (1.5) versus 17.2 (1.7) ml/min/kg; difference (95% CI) 6.72 (3.15 to
10.28); p<0.01) and three patients changed from a cardiac limitation
to exercise before pneumonectomy to pulmonary limitation afterwards.
CONCLUSIONSNeither
thoracotomy alone nor limited lung resection has a significant effect
on exercise capacity. Only pneumonectomy is associated with impaired
exercise performance, and then perhaps not as much as might be expected.
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