Anatomical lung resection in patients with severely impaired pulmonary function

Abstract Background Predicted postoperative forced expiratory volume in 1 s (ppoFEV1) and expected transfer factor for CO (TLCO) values < 30–35% are often considered to be a contraindication for anatomical lung resection in patients with lung cancer. Based on our prior positive experience in lung volume reduction surgery (LVRS), we retrospectively analyzed all patients with impaired pulmonary function undergoing anatomical minimally-invasive lung resection, either for LVRS or treatment of non-small cell lung cancer (NSCLC) at our institute. Methods From August 2016 to April 2021, n = 42 consecutive anatomical lung resections were performed in patients with poor lung function (< 35% ppoFEV1). We retrospectively searched our records and investigated the patients’ pre- and postoperative conditions and their outcome. Results We included 16 patients (9 males, age 68.4 ± 8.9 years old) scheduled for lung cancer surgery. The procedures were performed via uniportal video assisted thoracoscopic surgery (VATS; n = 10, 62.5%, including one non-intubated VATS) or via thoracotomy (n = 6, 37.5%) and included lobectomy (9 patients, 55.3%) or (multiple) segmentectomy. Resected parenchyma as described by total number of removed segments was 3.9 ± 1.6 segments. Preoperative FEV1 was 35.1 ± 7.2%, with an expected ppoFEV1 28.1 ± 5.9%. Measured postoperative FEV1 was 39 ± 8.7% (p < 0.001). Postoperative complications included persistent air leak (PAL) in 7 patients (43.8%), atelectasis in 3 (18.8%), pleural effusion in 4 (25%), pneumonia in 1 (6.3%), and empyema in one (6.3%), patients. No patient required continuous O2 therapy or died. Conclusions Even in severely impaired lung function, anatomical resection appears to be feasible with reasonable morbidity and mortality.