Background: The unknown but presumably poor preoperative cardiopulmonary function of U.S. Armed Forces veterans with bronchogenic cancer may dissuade surgeons performing necessary major lung resection. The purpose of this study was to investigate the relationship between preoperative cardiopulmonary risk and the outcome of veterans undergoing pulmonary resection for bronchogenic carcinoma.
Methods: A retrospective chart review was performed on 79 veterans who underwent lung resection for bronchogenic cancer between March 1990 and June 1995. Preoperative cardiac function was assessed by 1) history of heart disease (myocardial infarction, previous open heart surgery, and hypertension), 2) electrocardiogram, EKG, and 3) transthoracic echocardiography, TTE (ejection fraction and left ventricular wall motion abnormalities). Pulmonary reserve was evaluated by 1) history of lung disease (active smoking, known chronic obstructive pulmonary disease, COPD), and 2) spirometry (forced expiratory volume in 1 second, FEV1, and minute ventilation volume, MVV). Resections were performed by standard pulmonary techniques and follow-up data was available in all patients.
Results: All patients were males except one, with a mean age of 66+/-1.0 yrs (range=32 to 81 yrs). Fifty-one patients (64.60%) had a history of COPD while one-third of the veterans were smoking and using excessive alcohol just prior to surgery. Twenty-four patients (29%) had abnormal preoperative EKG and only 10 (15%) had prior myocardial infarction. Eleven patients (13.9%) had undergone previous coronary bypass surgery. Average preoperative left ventricular ejection fraction was 63+/-2% (range=41 to 80%) and left ventricular wall motion abnormalities were present in only 6 patients (8%). Mean preoperative FEV1 was 2.2+/-0.1 L (range=0.6-4.1 L) and MW was 87+/-4 L/min (range=26-198 L/min). A lobectomy was performed in 68 patients (86.1%), pneumonectomy in 10 (12.7%), and wedge resection in 1 (1.2%). The most common types of cancer were squamous cell (36 patients) and adenocarcinoma (31 patients). While pulmonary complications (atelectasis, prolonged air leak, pneumonia) occurred in 8 patients (10%), only two (3%) suffered nonpulmonary complications (ischemic bowel disease). For all veterans with bronchogenic cancer, early (30-day) mortality after major lung resection was 3.9% (3/79): 1.5% (1/68) after lobectomy, and 20% (2/10) after pneumonectomy (p=not significant). Overall survival at 5 years was 39.5%.
Conclusions: Preoperative cardiopulmonary risk for veterans with bronchogenic cancer is acceptable and lung resection can be performed with good outcomes in this distinct patient population.