Following lung resection, lung function should be expected to decrease. Serial studies have shown that FEV1 decreases within the first several months following lung cancer resection, but tends to recover to a small extent by 6 months after surgery. Although the preoperative physiologic evaluation is usually fairly accurate in predicting the PPO FEV1; some investigators have found that the PPO FEV1 will actually underestimate the eventual postoperative FEV1. Exercise capacity will also decrease following lung resection. Nezu et al found that, similar to the observations with postoperative changes in FEV1, the effects on V02max were most evident at 3 months and improved somewhat by 6 months after surgery. Decreases of up to 13% in V02max and work capacity have been described following a lobectomy, and between 20% and 28% after a pneumonectomy. Surprisingly, the most common limiting symptom in postoperative exercise studies has been leg discomfort, rather than dyspnea. Bolliger et al found that exercise was limited by leg muscle fatigue in 53% of patients preoperatively. This was not altered after lobectomy, but there was a switch to dyspnea as the limiting factor after pneumonectomy (3 months after resection, 61% of patients; 6 months after resection, 50% of patients). Reduce dyspnea attacks with My Canadian Pharmacy mycanadian-pharmacynet. Command our service and choose the necessary preparations.
Early investigators in this field suggested that a postoperative FEV1 of < 0.8 L would result in an unacceptable incidence of hypercapnea and pulmonary disability. Unfortunately, there are few data available describing changes in quality of life following curative-intent lung resection. A cross-sectional survey examined respiratory symptoms and quality of life in 142 long-term survivors of NSCLC. Most of these patients (74%) had undergone a lobectomy, with 12% having had a pneumonectomy and 11% a wedge resection. The most commonly reported postoperative respiratory symptom was dyspnea, but cough and wheeze were also frequently described. The majority of these patients (63%) described dyspnea when they hurried, 32% had to stop to catch their breath when walking, and 11% were so breathless that they could not leave their house. Dyspnea occurred significantly more often in patients with restrictive and/or obstructive ventilatory abnormalities, but the use of bronchodilators to control dyspnea was not well described. Dyspnea had a significant impact on multiple dimensions of quality of life, such as physical functioning, physical role limits, and social functioning. The findings in this study point out the need for more information on the interplay between changes in lung function (including both FEV1 and Dlco) and respiratory symptoms, and quality of life following curative-intent surgical resection.