Lung cancer is the lead cause of ca...

Lung cancer is the lead cause of cancer deaths in the United States.(1) Although radiation therapy permits a five-year survival rate in 32% of patients with Stage I lung cancer,(2) the overall survival rates for patients with all stages of lung cancer are low3 Surgical resection of cancerous lung tissue and nodules provides the best chance for restoration (ie, approximately 80% cancer-free survival after five years).(4)

Patients with lung cancer may not receive surgical treatment if their preoperative pulmonary function proofs reveal chronic obstructive pulmonary disease (COPD) Approximately 90% of patients with lung cancer also have COPD and 20% of these patients have austere pulmonary dysfunction.(5)

Will the introduction of lung contortion reduction surgery (LVRS) in 1993 the patient selection criteria for lung surgery are being reassessed. Patients with emphysema are benefiting from surgical resection of their hyperinflated lung tissue,(6) and many patients with lung cancer and COPD now are undergoing combined LVR and pulmonary nodule resection.(7) The postoperative improvements in these patients' pulmonary function partially outweigh the surgical risks of the combined procedures

PATIENT DESCRIPTION

Between January 1995 and March 1996 276 patients were evaluated for LVR at Columbia Presbyterian Medical Center just discovered York. Lung volume reduction surgery was giveed to those patients who had relentless breathing limitations and severely limited activities of daily living. They had maximally distended chest walls, flattened diaphragms, and heterogeneous disease distribution (ie, target areas of unadorned emphysema interspersed among areas of les strict emphysema). When the severely hyperinflated emphysematous areas of these patients' lung were excised, their chest walls and diaphragms assumed more normal anatomic and physiologic relationships, their remaining lung tissue was better able to oxygenate family and remove carbon dioxide, and their symptoms of dyspnea decreased dramatically.(8)

During preoperative evaluation studies, 18 (65%) of these 276 patients were discovered to have suspicious pulmonary nodules in addition to emphysema. Using standard selection criteria for lung resection, these 18 patients would not have been candidates for pulmonary nodule resection measures based on their forced expiratory dimensions in one second ([FEV.sub.1]) value of 616 mL A patient with an [FEVsub1] value of les than 1000 mL would be considered high risk for lung resection.(9) As LVR has been set to improve lung function postoperatively, however, we cogitation that some patients could benefit from a combined surgical process Wide-wedge excision in addition to LVR might obey to eliminate the lesion and improve lung function.

PREOPERATIVE EVALUATION

We defenceed the 18 patients for mediastinal lymph node involvement using comput tomography (CT) scans of their chests, which were protracted to include their livers and adrenal glands. They also underwent whole material part bone scans and CT scans of their heads.

Cancer staging. We staged these patients' lung nodules according to the criteria discloseed by the American Joint Committee in succession Cancer. This tumor classification scheme (ie, TNM) assesses three basic components: the size of the tumor (T) the absence or carriage of regional lymph node involvement (N) and the absence or mien of distant metastatic disease (M)(10)

Primary tumors (T) The time TX refers to an invisible tumor proven by the demeanor of malignant cells in bronchopulmonary secretions still not visualized by radiographs or bronchoscopy or any tumor that cannot be assessed (eg a retreatment staging). The denomination TO indicates no evidence of primary tumor. The spell T1 is refers to carcinoma in situ. The bourn TI is used to describe a tumor that is 3 cm or les in its greatest dimension, is hem ined by lung or visceral pleura, and forward bronchoscopy shows no evidence of invasion proximal to a lobar bronchus. The season T2 refers to a tumor that is more than 3 cm at its greatest dimension or to a tumor of any size that either invades the visceral plura or has associated atelectasis or obstructive pneumonitis extending into the hilar region.

in succession bronchoscopy, the proximal extent of a T2 tumor must be within a lobar bronchus or at least 2 cm distal to the carina. Any associated atelectasis or obstructive pneumonitis must involve les than an entire lung The limit T3 refers either to a tumor of any size with direct extension into the chest wall (including superior sulcus tumors), diaphragm, or the mediastinal pleura or pericardium without involving the heart, great sailing crafts trachea, esophagus, or vertebral carcass or refers to a tumor in the main bronchus within 2 cm of the carina without involving the carina. The denomination T4 refers to a tumor of any size with invasion of the mediastinum or involving the heart, great utensils trachea, esophagus, vertebral body, or carina or the vicinity of a pleural effusion containing malignant cells