Clinical Data

Observation of intermediate results after the procedure has confirmed the experimental data. Deslauriers and colleagues confirmed in 19 patients that the reimplanted lung contributed substantially to overall lung function.37 In 15 patients after right bronchoplasty, the right lung received 41% of perfusion, whereas the left lung in 4 patients after left bronchoplasty captured 29% of perfusion. Figures 16-3 and 16-4 describe the forced vital capacity (FVC) and postoperative scintigraphy in their patients. Brusasco and colleagues also studied patients with spirometry and ventilation-perfusion scintigraphy.38 Two weeks after sleeve lobectomy, they found a slightly, but significantly higher forced expiratory volume in 1 second (FEVi) compared with standard lobectomy. Over 3 to 12 months, they found significant improvements of figure 16-3 Individual and mean (± standard deviation) forced vital capacity (FVC) before and after sleeve lobectomy in 12 patients with pre-and postoperative spirometry, as reported by Deslauriers and colleagues.37 NS = not significant. Reprinted with permission from Deslauriers J et al37

figure 16-4 Results (mean ± standard deviation) for perfusion, ventilation, and washout curves for all 15 patients after right lung sleeve lobectomy, as reported by Deslauriers and colleagues.37 MAA = macroaggregated albumin; Xe133 = 133Xenon. Reprinted with permission from Deslauriers J et al.37

regional ventilation and perfusion in both types of lobectomy, with a higher regional ventilation after sleeve lobectomy.

Postoperative lung function may be predicted by calculation of the expected functional loss using the following equation:

(number of functional segments in the lobe to be resected)

preoperative FEVi x _

(total number of segments in both lungs)

Khargi and colleagues noted a good correlation between predicted postoperative FEV1 and measured postoperative FEV1 in 109 patients who had spirometry 25 to 342 days after sleeve lobectomy.29 Thus, postoperative FEV1, although not necessarily the functional outcome, may be reliably predicted in every patient from preoperative pulmonary function tests and from ventilation and perfusion scintigraphy.

In a group of 52 patients with resection of the pulmonary artery, as reported by Rendina and colleagues, the mean FEV and FVC were, respectively, 72% and 80% before operation and 65% and 76% at 1 month after surgery, and then reached their plateau at 70% and 78% after 6 months.39 Echocardiography showed patterns in the normal range and normal estimates of pulmonary artery (PA) pressures in all but 2 patients. These values indicate that lobectomy with PA resection may be followed by limited loss of spiro-metric lung function.

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