Thoracoscopic partial lung resection in patients with severe chronic obstructive pulmonary disease. A preliminary report.

OBJECTIVE: To determine if patients with severe chronic obstructive pulmonary disease can tolerate thoracoscopic partial lung resection. DESIGN: Patients 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. SETTING: A private community hospital with nationwide referrals. PATIENTS: Nine 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%). INTERVENTIONS: With 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 OUTCOMES: All 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. RESULTS: One patient died of disease progression 4 months after surgery. There was one local recurrence and one distant metastasis. Four patients remained free of tumors. CONCLUSIONS: Patients with severe chronic obstructive pulmonary disease can tolerate thoracoscopic partial lung resection but an effort should be made to reduce local recurrence.