Long-term Surgical Outcome in Patients with Lung Cancer and Coexisting Severe COPD

Abstract

Background: The functional criteria for curative surgery for patients with non-small cell lung cancer (NSCLC) and coexisting chronic obstructive pulmonary disease (COPD) remain controversial. We aimed to clarify long-term outcomes after resection. Methods: Between January 1990 and April 2005, 36 consecutive patients with NSCLC and severe COPD underwent pulmonary resection. All had severe (30–50 % pred FEV1) or very severe COPD (30 % > pred FEV1) preoperatively. Survival, short- and long-term complications were analyzed retrospectively. Prognostic factors were also analyzed. Results: The 5-year survival rate of these patients was significantly worse than that of patients with better pulmonary function (50 % < pred FEV1) (p < 0.0001). Patients with interstitial pneumonia (IP) had a significantly poorer prognosis (p = 0.0099). With regard to long-term complications three months after surgery, 30 % of patients reported worsening of dyspnea, and 20 % experienced pneumonia recurrence. No deaths were related to COPD progression. Conclusion: Patients with stage IA NSCLC and severe COPD may undergo curative surgical resection; however, postoperative complications and long-term survival remain unsolved problems. IP is a contraindication for surgery in patients with severe COPD.

Key words

lung cancer surgery - perioperative care - chronic obstructive pulmonary disease - long‐term survival - interstitial pneumonia

References

• 1 Choong C K, Meyers B F, Battafarano R J et al. Lung cancer resection combined with lung volume reduction in patients with severe emphysema.  J Thorac Cardiovasc Surg. 2004;  127 1323-1331
• 2 Pompeo E, De Dominicis E, Ambrogi V, Mineo D, Elia S, Tommaso C M. Quality of life after tailored combined surgery for stage I non-small-cell lung cancer and severe emphysema.  Ann Thorac Surg. 2003;  76 1821-1827
• 3 Licker M J, Widikker I, Robert J et al. Operative mortality and respiratory complications after lung resection for cancer: impact of chronic obstructive pulmonary disease and time trends.  Ann Thorac Surg. 2006;  81 1830-1837
• 4 Linden P A, Bueno R, Colson Y L et al. Lung resection in patients with preoperative FEV1 < 35 % predicted.  Chest. 2005;  127 1984-1990
• 5 Sekine Y, Iwata T, Chiyo M et al. Minimal alteration of pulmonary function after lobectomy in lung cancer patients with chronic obstructive pulmonary disease.  Ann Thorac Surg. 2003;  76 356-361
• 6 Baldi S, Ruffini E, Harari S et al. Does lobectomy for lung cancer in patients with chronic obstructive pulmonary disease affect lung function? A multicenter national study.  J Thorac Cardiovasc Surg. 2005;  130 1616-1622
• 7 Sekine Y, Chiyo M, Iwata T et al. Perioperative rehabilitation and physiotherapy for lung cancer patients with chronic obstructive pulmonary disease.  Jpn J Thorac Cardiovasc Surg. 2005;  53 237-243
• 8 Fabbri L M, Luppi F, Beghe B, Rabe K F. Update in chronic obstructive pulmonary disease 2005.  Am J Respir Crit Care Med. 2006;  173 1056-1065
• 9 Barnes N C, Qiu Y S, Pavord I D et al. Anti-inflammatory effects of salmeterol/fluticasone propionate in chronic obstructive lung disease.  Am J Respir Crit Care Med. 2006;  173 736-743
• 10 Simpson J R, Bauer M, Perez C A et al. Radiation therapy alone or combined with misonidazole in the treatment of locally advanced non-oat cell lung cancer: report of an RTOG prospective randomized trial.  Int J Radiat Oncol Biol Phys. 1989;  16 1483-1491
• 11 Yamada K, Iwai K, Kawamorita R et al. Change in dose distribution of three dimensional conformal radiotherapy during treatment for lung tumor.  Radiat Med. 2006;  24 122-127
• 12 Inoue A, Kunitoh H, Sekine I et al. Radiation pneumonitis in lung cancer patients: a retrospective study of risk factors and the long-term prognosis.  Int J Radiat Oncol Biol Phys. 2001;  49 649-655
• 13 Papi A, Casoni G, Caramori G et al. COPD increases the risk of squamous histological subtype in smokers who develop non-small cell lung carcinoma.  Thorax. 2004;  59 679-681
• 14 Iizasa T, Suzuki M, Yasufuku K et al. Preoperative pulmonary function as a prognostic factor for stage I non-small cell lung carcinoma.  Ann Thorac Surg. 2004;  77 1896-1902
• 15 Sekine Y, Behnia M, Fujisawa T. Impact of COPD on pulmonary complications and on long-term survival of patients undergoing surgery for NSCLC.  Lung Cancer. 2002;  37 95-101
• 16 Port J L, Kent M, Korst R J et al. Surgical resection for lung cancer in the octogenarian.  Chest. 2004;  126 733-738
• 17 Kuller L H, Ockene J, Meilahn E, Svendsen K H. Relation of forced expiratory volume in one second (FEV1) to lung cancer mortality in the Multiple Risk Factor Intervention Trial (MRFIT).  Am J Epidemiol. 1990;  132 265-274
• 18 Schwartz A G, Ruckdeschel J C. Familial lung cancer: genetic susceptibility and relationship to chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 2006;  173 16-22