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Vol. 43. Issue 5.
Pages 262-266 (January 2007)
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Vol. 43. Issue 5.
Pages 262-266 (January 2007)
Original Articles
DOI: 10.1016/S1579-2129(07)60064-0
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Impact of a Rescue Program on the Operability of Patients With Bronchogenic Carcinoma and Chronic Obstructive Pulmonary Disease
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Guillem Gómez Sebastiána,
Corresponding author
ggomezs@hsp.santpau.es

Correspondence: Dr. G. Gómez Sebastián. Servicio de Cirugía Torácica. Hospital de la Santa Creu i Sant Pau. Sant Antoni M. Claret, 167. 08025 Barcelona. España
, Rosa Güell Rousb,c, Araceli González Valenciab, Juan José Fibla Alfaraa, Gaspar Estrada Salóa, Carlos León Gonzáleza
a Servicio de Cirugía Torácica, Hospital de la Santa Creu i Sant Pau, Facultat de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
b Departamento de Neumología, Hospital de la Santa Creu i Sant Pau, Facultat de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
c RTIC-ISCIII-Red Respira, Hospital de la Santa Creu i Sant Pau, Facultat de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
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Objective

Bronchogenic carcinoma and chronic obstructive pulmonary disease (COPD) are strongly associated in our setting, occurring together in around 70% of cases. Approximately 60% of COPD patients who require resection for bronchogenic carcinoma are considered unfit for surgery because of seriously impaired lung function. The purpose of this study was to evaluate the extent to which a rescue program could improve lung function in COPD patients who had previously been considered unfit for surgery because of poor lung function.

Patients and methods

The study enrolled COPD patients who had not been considered for surgical resection because they had a predicted postoperative forced expiratory volume in 1 second (FEV1) of less than 1 L. All of the patients participated in a 2-week rescue program that involved optimization of drug treatment (inhaled bronchodilators and/or corticosteroids) and intensive respiratory physiotherapy. Lung function was analyzed before and after the program.

Results

We evaluated 30 patients (26 men and 4 women) with a mean (SD) age of 66.7 (8.15) years and an initial FEV1 of 1.497 (0.27) mL (FEV1 % of 55.7% [20.14%]). None of the patients had respiratory failure (PaO2 of 77.0 [9.4] mm Hg and PaCO 2 of 41.6 [2.4] mm Hg). Twenty-four patients (80%) showed significant improvement in lung function (P<.001) after the program and were admitted for resection.

Two wedge resections, 18 lobectomies, 2 pneumonectomies, and 2 exploratory thoracotomies were performed (based on oncologic indications). Nineteen of the 24 patients who underwent surgery had no complications. Two patients had prolonged air leaks, 1 empyema, and 1 hemothorax. One patient died from sepsis.

Conclusions

A large number (80%) of COPD patients previously considered unfit for surgical resection because of seriously impaired lung function can be admitted for surgery following an intensive drug and respiratory physiotherapy rescue program.

Key words:
Bronchogenic carcinoma
COPD
Surgical resection
Respiratory physiotherapy
Objetivo

La asociación entre carcinoma broncogénico y enfermedad pulmonar obstructiva crónica (EPOC) se sitúa en torno al 70% en nuestro medio. Aproximadamente un 60% de los pacientes con dichos diagnósticos son rechazados para cirugía de resección del carcinoma broncogénico debi-do a la intensa alteración de su función pulmonar. El objeti-vo del presente trabajo es evaluar el efecto de un programa de rescate en la mejoría de la función pulmonar de pacientes con EPOC y previamente descartados para cirugía por la alteración de su función pulmonar.

Pacientes y métodos

Se incluyó en el estudio a pacientes con EPOC descartados inicialmente porque se había calcu-lado que su volumen espiratorio forzado en el primer segun-do (FEV1) tras la intervención quirúrgica sería menor de 1 l. Todos ellos participaron en un programa de rescate de 2 se-manas de duración que incluía: optimización del tratamien-to farmacológico (broncodilatadores inhalados y/o corticoi-des) y fisioterapia respiratoria intensiva. Se analizó la función pulmonar antes y después del programa.

Resultados

Se evaluó a 30 pacientes (26 varones y 4 muje-res) con una edad media ± desviación estándar de 66,7 ± 8,15 años y FEV1 inicial de 1,497 ± 0,27 ml (FEV1 %: 55,7 ± 20,14 l), que no presentaban insuficiencia respiratoria (presión ar-terial de oxígeno: 77,0 ± 9,4 mmHg; presión arterial de an-hídrido carbónico: 41,6 ± 2,4 mmHg). Tras el programa 24 pacientes (80%) pudieron ser aceptados para la resección propuesta al objetivarse una mejoría significativa en la fun-ción pulmonar (p < 0,001).

Se realizaron 2 resecciones en cuña, 18 lobectomías, 2 neumonectomías y 2 toracotomías exploradoras (por crite-rios oncológicos). De los 24 pacientes a los que se intervino, en 19 no hubo complicaciones, 2 presentaron fugas aéreas mantenidas, hubo un caso de empiema pleural y otro de he-motórax. Un paciente falleció por sepsis.

Conclusiones

El diseño de un programa intensivo far-macológico y de fisioterapia respiratoria permite rescatar para cirugía a un número alto (80%) de los pacientes con EPOC a los que inicialmente se descarta por una alteración importante de la función pulmonar.

Palabras clave:
Carcinoma broncogénico
EPOC
Cirugía de re-sección
Fisioterapia respiratoria
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Copyright © 2007. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
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