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Value of Wedge Resection for Lung Cancer in Poor Cardiopulmonary Status Patients

Division of Thoracic Surgery, Bristol Royal Infirmary, Bristol, United Kingdom

For reprint information contact: Balakrishnan Mahesh, FRCS Tel: 44 795 103 3090 Fax: 44 189 582 8900, Email: b.mahesh{at}imperial.ac.uk, Transplant Immunology, Heart Science Centre, Harefield Hospital, Harefield UB9 6JH, United Kingdom.

The strategic management of primary lung cancer in patients with poor cardiopulmonary status is still controversial. The aim of this study was to ascertain the early and late results of wide-margin wedge resection with curative intent in this group of patients. Between January 1995 and January 2002, 24 patients (13 males; mean age, 69.96 years) with baseline poor cardiopulmonary status underwent wide-margin wedge resection of preoperatively diagnosed primary lung cancer. All patients suffered from chronic obstructive pulmonary disease and 9 (37.5%) also had symptomatic ischemic heart disease. Eight patients were in New York Heart Association class III and 12 were in class IV. There were no post-operative deaths. Complications included chest infection in 3, surgical emphysema with prolonged air leak in 1, and atrial fibrillation in 6. Overall 7-year survival was 23.3%. Three patients with ischemic heart disease suffered late non-cancer-related death due to myocardial infarction at 48, 60, and 60 months postoperatively. Cancer-free 5-year survival was 54.3%, with 7/24 (29%) late recurrences. Our study suggests that wide-margin wedge resection is a valuable surgical option for primary lung cancer in patients with poor cardiopulmonary status.