General Thoracic and Cardiovascular Surgery

, Volume 62, Issue 1, pp 24–30 | Cite as

Long-term pulmonary function after major lung resection

  • Kazuhiro Ueda
  • Masataro Hayashi
  • Nobuyuki Tanaka
  • Toshiki Tanaka
  • Kimikazu Hamano
Current Topics Review Article

Abstract

The function of the remaining lungs after major lung resection may be a determinant of the early postoperative outcome, as well as the late postoperative quality of life of the patient. Thus, extensive efforts have been made to accurately estimate the postoperative pulmonary function using a variety of methods: the segment counting method is utilized in patients without parenchymal diseases, while the functional lung imaging technique may be useful in patients with heterogeneous anatomical lung diseases. The postoperative pulmonary function is influenced not only by the extent of parenchymal resection, but also by various other factors, such as the site of resection, the mode of thoracotomy, the severity of pulmonary emphysema and/or the postoperative progression of pulmonary fibrosis. Although thoracoscopic surgery or segmental resection can lessen the extent of chest wall damage or the extent of parenchymal resection compared with conventional operations, the resulting functional benefits do not last. Interestingly, the postoperative pulmonary function continues to improve during the first postoperative year as if the remaining lungs grow, although the cause(s) of this compensatory response of the remaining lungs remains unclear. Such an ability of the remaining lung to compensate for the lost lung function may eventually determine the late postoperative pulmonary function.

Keywords

Pulmonary function Lobectomy Segmentectomy Compensatory lung growth 

Notes

Conflict of interest

The authors have declared that no conflict of interest exists.

References

  1. 1.
    Colice GL, Shafazand S, Griffin JP, Keenan R, Bolliger CT, American College of Chest Physicians. Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: ACCP evidenced-based clinical practice guidelines (2nd edition). Chest. 2007;132:161S–77S.PubMedCrossRefGoogle Scholar
  2. 2.
    Ali MK, Mountain CF, Ewer MS, Johnston D, Haynie TP. Predicting loss of pulmonary function after pulmonary resection for bronchogenic carcinoma. Chest. 1980;77:337–42.PubMedCrossRefGoogle Scholar
  3. 3.
    Nakahara K, Ohno K, Hashimoto J, Miyoshi S, Maeda H, Matsumura A, et al. Prediction of postoperative respiratory failure in patients undergoing lung resection for lung cancer. Ann Thorac Surg. 1988;46:549–52.PubMedCrossRefGoogle Scholar
  4. 4.
    Bremer JL. The fate of the remaining lung tissue after lobectomy or pneumonectomy. J Thorac Surg. 1936;6:336–43.Google Scholar
  5. 5.
    Filaire M, Bedu M, Naamee A, Aubreton S, Vallet L, Normand B, et al. Prediction of hypoxemia and mechanical ventilation after lung resection for cancer. Ann Thorac Surg. 1999;67:1460–5.PubMedCrossRefGoogle Scholar
  6. 6.
    Ueda K, Kaneda Y, Sudoh M, Jinbo M, Tanaka N, Suga K, et al. Role of quantitative CT in predicting hypoxemia and complications after lung lobectomy for cancer, with special reference to area of emphysema. Chest. 2005;128:3500–6.PubMedCrossRefGoogle Scholar
  7. 7.
    Brunelli A, Refai M, Salati M, Xiumè F, Sabbatini A. Predicted versus observed FEV1 and DLCO after major lung resection: a prospective evaluation at different postoperative periods. Ann Thorac Surg. 2007;83:1134–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Brunelli A, Xiumè F, Refai M, Salati M, Marasco R, Sciarra V, et al. Evaluation of expiratory volume, diffusion capacity, and exercise tolerance following major lung resection: a prospective follow-up analysis. Chest. 2007;131:141–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Bolliger CT, Jordan P, Solèr M, Stulz P, Tamm M, Wyser C, et al. Pulmonary function and exercise capacity after lung resection. Eur Respir J. 1996;9:415–21.PubMedCrossRefGoogle Scholar
  10. 10.
    Veneskoski T, Sivijärvi ARA, Muittari A. Effect of lung resection on regional lung function assessed by 133Xe radiospirometry. Lung. 1982;160:45–55.CrossRefGoogle Scholar
  11. 11.
    Funakoshi Y, Takeda S, Sawabata N, Okumura Y, Maeda H. Long-term pulmonary function after lobectomy for primary lung cancer. Asian Cardiovasc Thorac Ann. 2005;13:311–5.PubMedCrossRefGoogle Scholar
  12. 12.
    Tamm M, Higgenbottam TW, Dennis CM, Sharples LD, Wallwork J. Donor and recipient predicted lung volume and lung size after heart-lung transplantation. Am J Respir Crit Care Med. 1994;150:403–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Bates DV, Macklem PT, Christie RV: Respiratory Function in Disease, 2nd ed. Philadelphia: WB Saunders; 1971. p. 258–9.Google Scholar
  14. 14.
    Butler JP, Loring SH, Patz S, Tsuda A, Yablonskiy DA, Mentzer SJ. Evidence for adult lung growth in humans. N Engl J Med. 2012;367:244–7.PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Zeiher BG, Gross TJ, Kern JA, Lanza LA, Peterson MW. Predicting postoperative pulmonary function in patients undergoing lung resection. Chest. 1995;108:68–72.PubMedCrossRefGoogle Scholar
  16. 16.
    Wang JS, Abboud RT, Wang LM. Effect of lung resection on exercise capacity and on carbon monoxide diffusing capacity during exercise. Chest. 2006;129:863–72.PubMedCrossRefGoogle Scholar
  17. 17.
    Nagamatsu Y, Maeshiro K, Kimura NY, Nishi T, Shima I, Yamana H, et al. Long-term recovery of exercise capacity and pulmonary function after lobectomy. J Thorac Cardiovasc Surg. 2007;134:1273–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg. 1995;60:615–22.PubMedCrossRefGoogle Scholar
  19. 19.
    Pelletier C, Lapointe L, LeBlanc P. Effects of lung resection on pulmonary function and exercise capacity. Thorax. 1990;45:497–502.PubMedCrossRefGoogle Scholar
  20. 20.
    Win T, Groves AM, Ritchie AJ, Wells FC, Cafferty F, Laroche CM. The effect of lung resection on pulmonary function and exercise capacity in lung cancer patients. Respir Care. 2007;52:720–6.PubMedGoogle Scholar
  21. 21.
    Sudoh M, Ueda K, Kaneda Y, Mitsutaka J, Li TS, Suga K, et al. Breath-hold single-photon emission tomography and computed tomography for predicting residual pulmonary function in patients with lung cancer. J Thorac Cardiovasc Surg. 2006;131:994–1001.PubMedCrossRefGoogle Scholar
  22. 22.
    Suga K, Kawakami Y, Zaki M, Yamashita T, Shimizu K, Matsunaga N. Clinical utility of co-registered respiratory-gated (99 m)Tc-Technegas/MAA SPECT-CT images in the assessment of regional lung functional impairment in patients with lung cancer. Eur J Nucl Med Mol Imaging. 2004;31:1280–90.PubMedCrossRefGoogle Scholar
  23. 23.
    Ueda K, Tanaka T, Li TS, Tanaka N, Hamano K. Quantitative computed tomography for the prediction of pulmonary function after lung cancer surgery: a simple method using simulation software. Eur J Cardiothorac Surg. 2009;35:414–8.PubMedCrossRefGoogle Scholar
  24. 24.
    Wu MT, Chang JM, Chiang AA, Lu JY, Hsu HK, Hsu WH, et al. Use of quantitative CT to predict postoperative lung function in patients with lung cancer. Radiology. 1994;191:257–62.PubMedGoogle Scholar
  25. 25.
    Ohno Y, Koyama H, Nogami M, Takenaka D, Onishi Y, Matsumoto K, et al. State-of-the-art radiological techniques improve the assessment of postoperative lung function in patients with non-small cell lung cancer. Eur J Radiol. 2011;77:97–104.PubMedCrossRefGoogle Scholar
  26. 26.
    Chae EJ, Kim N, Seo JB, Park JY, Song JW, Lee HJ, et al. Prediction of postoperative lung function in patients undergoing lung resection: dual-energy perfusion computed tomography versus perfusion scintigraphy. Invest Radiol. 2013;48:622–7.PubMedCrossRefGoogle Scholar
  27. 27.
    Bolliger CT, Guckel C, Engel H, Stohr S, Wyser CP, Schoetzau A, et al. Prediction of functional reserves after lung resection: comparison between quantitative computed tomography, scintigraphy, and anatomy. Respiration. 2002;69:482–9.PubMedCrossRefGoogle Scholar
  28. 28.
    Holvoet T, van Meerbeeck JP, Van De Wiele C, Salhi B, Derom E. Quantitative perfusion scintigraphy or anatomic segment method in lung cancer resection. Lung Cancer. 2011;74:212–8.PubMedCrossRefGoogle Scholar
  29. 29.
    Brunelli A, Pompili C, Refai M, Xiumè F, Salati M, Sabbatini A. Predicted versus observed peak oxygen consumption after major pulmonary resection. Ann Thorac Surg. 2012;94:222–5.PubMedCrossRefGoogle Scholar
  30. 30.
    Keenan RJ, Landreneau RJ, Maley RH Jr, Singh D, Macherey R, Bartley S, et al. Segmental resection spares pulmonary function in patients with stage I lung cancer. Ann Thorac Surg. 2004;78:228–33.PubMedCrossRefGoogle Scholar
  31. 31.
    Takizawa T, Haga M, Yagi N, Terashima M, Uehara H, Yokoyama A, et al. Pulmonary function after segmentectomy for small peripheral carcinoma of the lung. J Thorac Cardiovasc Surg. 1999;118:536–41.PubMedCrossRefGoogle Scholar
  32. 32.
    Okada M, Koike T, Higashiyama M, Yamato Y, Kodama K, Tsubota N. Radical sublobar resection for small-sized non-small cell lung cancer: a multicenter study. J Thorac Cardiovasc Surg. 2006;132:769–75.PubMedCrossRefGoogle Scholar
  33. 33.
    Harada H, Okada M, Sakamoto T, Matsuoka H, Tsubota N. Functional advantage after radical segmentectomy versus lobectomy for lung cancer. Ann Thorac Surg. 2005;80:2041–5.PubMedCrossRefGoogle Scholar
  34. 34.
    Ueda K, Tanaka T, Hayashi M, Li TS, Tanaka N, Hamano K. Computed tomography-defined functional lung volume after segmentectomy versus lobectomy. Eur J Cardiothorac Surg. 2010;37:1433–7.PubMedCrossRefGoogle Scholar
  35. 35.
    Yoshimoto K, Nomori H, Mori T, Kobayashi H, Ohba Y, Shibata H, et al. Quantification of the impact of segmentectomy on pulmonary function by perfusion single-photon-emission computed tomography and multidetector computed tomography. J Thorac Cardiovasc Surg. 2009;137:1200–5.PubMedCrossRefGoogle Scholar
  36. 36.
    Khargi K, Duurkens VA, Verzijlbergen FF, Huysmans HA, Knaepen PJ. Pulmonary function after sleeve lobectomy. Ann Thorac Surg. 1994;57:1302–4.PubMedCrossRefGoogle Scholar
  37. 37.
    Tedder M, Anstadt MP, Tedder SD, Lowe JE. Current morbidity, mortality, and survival after bronchoplastic procedures for malignancy. Ann Thorac Surg. 1992;54:387–91.PubMedCrossRefGoogle Scholar
  38. 38.
    Perentes J, Bopp S, Krueger T, Gonzalez M, Jayet PY, Lovis A, et al. Impact of lung function changes after induction radiochemotherapy on resected T4 non-small cell lung cancer outcome. Ann Thorac Surg. 2012;94:1815–22.PubMedCrossRefGoogle Scholar
  39. 39.
    Granone P, Cesario A, Margaritora S, Galetta D, Valente S, Corbo GM, et al. Morbidity after induction therapy and surgery in non small cell lung cancer (NSCLC). Focus on pulmonary function. Lung Cancer. 2002;36:219–20.PubMedCrossRefGoogle Scholar
  40. 40.
    Sekine Y, Iwata T, Chiyo M, Yasufuku K, Motohashi S, Yoshida S, et al. Minimal alteration of pulmonary function after lobectomy in lung cancer patients with chronic obstructive pulmonary disease. Ann Thorac Surg. 2003;76:356–61.PubMedCrossRefGoogle Scholar
  41. 41.
    Rapicetta C, Tenconi S, Voltolini L, Luzzi L, Scala V, Gotti G. Impact of lobectomy for non-small-cell lung cancer on respiratory function in octogenarian patients with mild to moderate chronic obstructive pulmonary disease. Eur J Cardiothorac Surg. 2011;39:555–9.PubMedCrossRefGoogle Scholar
  42. 42.
    Ueda K, Tanaka T, Hayashi M, Li TS, Kaneoka T, Tanaka N, et al. Compensation of pulmonary function after upper lobectomy versus lower lobectomy. J Thorac Cardiovasc Surg. 2011;142:762–7.PubMedCrossRefGoogle Scholar
  43. 43.
    Sengul AT, Sahin B, Celenk C, Basoglu A. Postoperative lung volume change depending on the resected lobe. Thorac Cardiovasc Surg. 2013;61:131–7.PubMedCrossRefGoogle Scholar
  44. 44.
    Ueda K, Tanaka T, Hayashi M, Tanaka N, Li TS, Hamano K. Clinical ramifications of bronchial kink after upper lobectomy. Ann Thorac Surg. 2012;93:259–65.PubMedCrossRefGoogle Scholar
  45. 45.
    Jubran A, Laghi F, Mazur M, Parthasarathy S, Garrity ER Jr, Fahey PJ, et al. Partitioning of lung and chest-wall mechanics before and after lung volume reduction surgery. Am J Respir Crit Care Med. 1998;158:306–10.PubMedCrossRefGoogle Scholar
  46. 46.
    Sciurba FC, Rogers RM, Keenan RJ, Slivka WA, Gorcsan J 3rd, Ferson PF, et al. Improvement in pulmonary function and elastic recoil after lung-reduction surgery for diffuse emphysema. N Engl J Med. 1996;334:1095–9.PubMedCrossRefGoogle Scholar
  47. 47.
    Laghi F, Jubran A, Topeli A, Fahey PJ, Garrity ER Jr, de Pinto DJ, et al. Effect of lung volume reduction surgery on diaphragmatic neuromechanical coupling at 2 years. Chest. 2004;125:2188–95.PubMedCrossRefGoogle Scholar
  48. 48.
    Korst RJ, Ginsberg RJ, Ailawadi M, Bains MS, Downey RJ Jr, Rusch VW, et al. Lobectomy improves ventilatory function in selected patients with severe COPD. Ann Thorac Surg. 1998;66:898–902.PubMedCrossRefGoogle Scholar
  49. 49.
    Endoh H, Tanaka S, Yajima T, Ito T, Tajima K, Mogi A, et al. Pulmonary function after pulmonary resection by posterior thoracotomy, anterior thoracotomy or video-assisted surgery. Eur J Cardiothorac Surg. 2010;37:1209–14.PubMedCrossRefGoogle Scholar
  50. 50.
    Kaseda S, Aoki T, Hangai N, Shimizu K. Better pulmonary function and prognosis with video-assisted thoracic surgery than with thoracotomy. Ann Thorac Surg. 2000;70:1644–6.PubMedCrossRefGoogle Scholar
  51. 51.
    Nagahiro I, Andou A, Aoe M, Sano Y, Date H, Shimizu N. Pulmonary function, postoperative pain, and serum cytokine level after lobectomy: a comparison of VATS and conventional procedure. Ann Thorac Surg. 2001;72:362–5.PubMedCrossRefGoogle Scholar
  52. 52.
    Nakata M, Saeki H, Yokoyama N, Kurita A, Takiyama W, Takashima S. Pulmonary function after lobectomy: video-assisted thoracic surgery versus thoracotomy. Ann Thorac Surg. 2000;70:938–41.PubMedCrossRefGoogle Scholar
  53. 53.
    Hsia CC, Herazo LF, Fryder-Doffey F, Weibel ER. Compensatory lung growth occurs in adult dogs after right pneumonectomy. J Clin Invest. 1994;94:405–12.PubMedCentralPubMedCrossRefGoogle Scholar
  54. 54.
    Macare′ van Maurik AF, Stubenitsky BM, van Swieten HA, Duurkens VA, Laban E, Kon M. Use of tissue expanders in adult postpneumonectomy syndrome. J Thorac Cardiovasc Surg. 2007;134:608–12.CrossRefGoogle Scholar
  55. 55.
    Jansen JP, Brutel de la Rivie` re A, Alting MP, Westermann CJ, Bergstein PG, Duurkens VA. Postpneumonectomy syndrome in adulthood. Surgical correction using an expandable prosthesis. Chest. 1992;101:1167–70.PubMedCrossRefGoogle Scholar
  56. 56.
    Hsia CC, Wu EY, Wagner E, Weibel ER. Preventing mediastinal shift after pneumonectomy impairs regenerative alveolar tissue growth. Am J Physiol Lung Cell Mol Physiol. 2001;281:L1279–87.PubMedGoogle Scholar
  57. 57.
    American Thoracic Society. American Thoracic Society Workshop Document. Mechanisms and limits of induced postnatal lung growth. Am J Respir Crit Care Med. 2004;170:319–43.CrossRefGoogle Scholar
  58. 58.
    Mizobuchi T, Chen F, Yoshino I, Iwata T, Yoshida S, Bando T, et al. Radiologic evaluation for volume and weight of remnant lung in living lung donors. J Thorac Cardiovasc Surg. 2013;146:1253–8.PubMedCrossRefGoogle Scholar
  59. 59.
    Mizobuchi T, Wada H, Sakairi Y, Suzuki H, Nakajima T, Tagawa T, et al. Spirometric and radiological evaluation of the remnant lung long after major pulmonary resection: can compensatory phenomena be recognized in clinical cases? Surg Today. 2013 (in print).Google Scholar

Copyright information

© The Japanese Association for Thoracic Surgery 2013

Authors and Affiliations

  • Kazuhiro Ueda
    • 1
  • Masataro Hayashi
    • 1
  • Nobuyuki Tanaka
    • 2
  • Toshiki Tanaka
    • 3
  • Kimikazu Hamano
    • 1
  1. 1.Department of Surgery and Clinical Science, Division of Chest SurgeryYamaguchi University Graduate School of MedicineUbeJapan
  2. 2.Department of Radiopathology and Science, Division of RadiologyYamaguchi University Graduate School of MedicineUbeJapan
  3. 3.Department of Thoracic SurgeryNHO Yamaguchi-Ube Medical CenterUbeJapan

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