Clinical value of quantitative ventilation-perfusion lung scans in the surgical management of bronchogenic carcinoma
Wernly, J.A.; Demeester, T.R.; Kirchner, P.T.; Myerowitz, P.D.; Oxford, D.E.; Golomb, H.M.
Journal of Thoracic and Cardiovascular Surgery 80(4): 535-543
1980
ISSN/ISBN: 0022-5223 PMID: 7421288 Document Number: 165339
Quantitative Xe 133 ventilation and Tc 99m macroaggregated albumin (MAA) perfusion scans were performed in 85 patients with lung cancer who had resection of their tumor. The expected reduction in postoperative function was calculated by spirometry and measurement of differential perfusion and/or ventilation. This was done to determine the best method of predicting pulmonary function. The predicted postoperative forced expiratory volumes in the 1st second (FEV1) from each of these calculations were compared to the observed postoperative FEV1 in 37 patients, 23 of whom had a pneumonectomy and 14 a lobectomy. FEV1 after pneumonectomy was predicted as accurately from the perfusion scan as from the ventilation scan. FEV1 after lobectomy was predicted with a mean percent error of < 10%. All patients requiring lung resection had their postoperative FEV1 predicted from the perfusion scan. Patients with a calculated postoperative FEV1 of < 1.0 l were considered medically inoperable. There were 3 deaths, 1 related to pulmonary insufficiency, among 45 patients who underwent pneumonectomy with a predicted postoperative FEV1 of > 1.0 l. Of these patients, 22 had a preoperative FEV1 < 2.0 l and would have not been considered candidates for pneumonectomy if preoperative function of each lung had been assumed to be equal. There were no surgically related deaths or cases of postoperative respiratory insufficiency among these patients. Some forty patients, 7 with a preoperative FEV1 < 1.5 l, underwent lobectomy, with no deaths or cases of postoperative respiratory insufficiency.