Lung volume reduction surgery alters management of pulmonary nodules in patients with severe COPD

Objective: To examine the role of lung volume reduction surgery (LVRS) in expanding the treatment options for patients with single pulmonary nodules and emphysema. Methods: Retrospective review of all patients undergoing LVRS at the University of Michigan between January 1995 and June 1996. Those undergoing simultaneous LVRS and resection of a suspected pulmonary malignancy formed the study group and underwent history and physical examination, pulmonary function tests, chest radiography, and high-resolution CT of the chest. If heterogeneous emphysema was found, cardiac imaging and single-photon emission CT perfusion lung scanning were performed. All study patients participated in pulmonary rehabilitation preoperatively. Age-and sex-matched patients who had undergone standard lobectomy for removal of pulmonary: malignancy during the same period formed the control group. Results: Of 75 patients who underwent LVRS, 11 had simultaneous resection of a pulmonary nodule. In 10 patients, the nodules were radiographically apparent with 1 demonstrating central calcification. Histologic evaluation revealed six granulomas, two hamartomas, and three neoplastic lesions (one adenocarcinoma, one squamous cell, and one large cell carcinoma). Preoperative FEV1 was 26.18 +/- 2.49% predicted in the LVRS group and 81.36 +/- 6.07% predicted (p = 0.000001) in the control group, and the FVC was 65.27 +/- 5.17% predicted vs 92.18 +/- 5.53% predicted (p = 0.002). Two LVRS patients had a PaCO2 >45 mm Hg while 11 exhibited oxygen desaturation during a G-min walk test. Postoperative complications occurred in two LVRS patients and three control patients. The mean length of stay in the LVRS group (7.55 +/- 1.10 days) was not different than in the control group (8.81 +/- 1.56 days). Three months after LVRS and simultaneous nodule resection, FEV, rose by 47%, FVC by 25%, and all study patients noted less dyspnea as measured by transitional dyspnea index. Conclusions: Simultaneous LVRS and resection of a suspected bronchogenic carcinoma is feasible and associated with minimal morbidity and significantly improved pulmonary function and dyspnea.