• A Wakabayashi.
• Department of Surgery, University of California-Irvine College of Medicine.
• Arch Surg Chicago. 1994 Sep 1;129(9):940-3; discussion 943-4.

ObjectiveTo determine if patients with severe chronic obstructive pulmonary disease can tolerate thoracoscopic partial lung resection.DesignPatients with non-small-cell lung cancers were selected from 583 cases undergoing laser treatment. The parameters studied included sex, age, tumor size, spirometry (forced vital capacity, forced expiratory volume in 1 second), operating time, operative mortality rate, postoperative ventilatory time, and length of hospital stay. The follow-up period varied from 4 to 30 months.SettingA private community hospital with nationwide referrals.PatientsNine consecutive patients (five men, four women) were found to have lung cancer before (four patients) or at (five patients) surgery. Their mean (+/- SD) age was 71.2 +/- 3.8 years; tumor size, 3.3 +/- 1.6 cm; forced vital capacity, 2.04 +/- 0.50 L (49.7% +/- 10.2%); and forced expiratory volume in 1 second, 0.66 +/- 0.11 L (22.2% +/- 5.5%).InterventionsWith patients under general anesthesia with one-lung ventilation, the tumor was resected and coexisting diffuse bullae were treated by a contact neodymium:YAG laser. Four patients received adjuvant therapies: chemotherapy, one; radiation and chemotherapy, one; radiation, one; and brachytherapy, one.Main OutcomesAll patients tolerated surgery; there were no deaths. Mean (+/- SD) operating time was 4.9 +/- 1.4 hours; postoperative ventilatory time, 10.3 +/- 6.8 hours; and length of hospital stay, 15.2 +/- 13.2 days.ResultsOne patient died of disease progression 4 months after surgery. There was one local recurrence and one distant metastasis. Four patients remained free of tumors.ConclusionsPatients with severe chronic obstructive pulmonary disease can tolerate thoracoscopic partial lung resection but an effort should be made to reduce local recurrence.

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