SYNOPSIS: Early-stage lung cancer is best treated by resection, but frequently patients with lung cancer and severe emphysema are denied this option because of poor preoperative pulmonary function. Lung volume reduction is now emerging as a means of resecting up to 30% of destroyed parenchyma, resulting in improvement in pulmonary function. Hence, this leads to the concept of combination therapy-resect the cancer and the decayed emphysematous tissue, leaving the patient cancer-free and with improved pulmonary status. The authors used this aggressive approach in a series of five patients with severe emphysema. Although their study sample was small, it is important to note that all did well postoperatively, and subjective and objective improvement was seen in serial postoperative pulmonary function tests (PFTs). The authors propose the combination of lung volume reduction surgery (LVRS) and lobectomy as a new option in the treatment of this difficult problem.
SOURCE: DeMeester SR et al. Lobectomy combined with volume reduction for patients with lung cancer and advanced emphysema. J Thorac Cardiovasc Surg 1998;115:681–8.