HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Larsen, K. R. Articles by Petersen, B. N. Search for Related Content PubMed PubMed Citation Articles by Larsen, K. R. Articles by Petersen, B. N.

Ann Thorac Surg 1997;64:960-964
© 1997 The Society of Thoracic Surgeons

---

Original Article: General Thoracic

Cardiopulmonary Function at Rest and During Exercise After Resection for Bronchial Carcinoma

Department of Pulmonary Medicine and Department of Thoracic and Heart Surgery, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark

Accepted for publication March 25, 1997.

	Abstract

Top Footnotes Abstract Introduction Material and Methods Patients Resting Lung Function Arterial Blood Gas Analysis Exercise Test Statistics Results Comment Acknowledgments References

 
Background. Measurements of postoperative spirometric values after pneumonectomy and lobectomy vary considerably, and few researchers have studied the changes in exercise capacity during maximal work after lung resection. The purpose of this study was to describe the postoperative alterations in cardiopulmonary function.

Methods. Ninety-seven consecutive patients with lung malignancy were prospectively examined with maximal exercise test, spirometry, and arterial gas tensions. Fifty-seven patients were reinvestigated 6 months postoperatively.

Results. In patients having lobectomy, forced expiratory volume in 1 second decreased 8%, and exercise capacity, expressed by maximal oxygen uptake and maximal work rate, significantly decreased 13%. In patients having pneumonectomy forced expiratory volume in 1 second significantly decreased 23%, but the loss in lung volume was partly compensated as measured by exercise capacity, which decreased only 16%. Generally patients with the smallest preoperative forced vital capacity had the smallest postoperative deterioration expressed in percentages. We found a weak correlation between alterations in maximal oxygen uptake and lung function after resection.

Conclusions. Lobectomy is associated with only minor deterioration of lung function and exercise capacity. Pneumonectomy causes a decrease in pulmonary volumes to about 75% of the preoperative values, partly compensated in better oxygen uptake, which postoperatively was about 85% of the preoperative values. Alteration in forced expiratory volume in 1 second is a poor predictor of change in exercise capacity after pulmonary resection.

	Introduction

Top Footnotes Abstract Introduction Material and Methods Patients Resting Lung Function Arterial Blood Gas Analysis Exercise Test Statistics Results Comment Acknowledgments References

 
The removal of lung parenchyma from patients with carcinoma of the lung, who are usually smokers with compromised cardiovascular or pulmonary status, may lead to cardiopulmonary failure or death. It is therefore a major factor in the determination of operability to assess the predicted residual pulmonary function after resection. Many centers recommend to operate without additional testing in patients with a preoperative forced expiratory volume in 1 second (FEV₁-preop) greater than 2.0 L or 60% of predicted and a diffusion capacity above 60% predicted [1–5]. If these requirements are not met, a radioisotope scintigraphy is performed to separate functional from nonfunctional lung tissue. A predicted postoperative FEV₁ less than 0.8 to 1.0 L is considered indicative of a high risk of postoperative chronic ventilatory insufficiency [5–8]. Although attempts in this way are made to identify patients with high surgical risk, the postoperative cardiopulmonary function is not always predictable. Measurements of changes in spirometric values after pneumonectomy and lobectomy vary considerably. Most consistent are the measurements after pneumonectomy with deterioration of 29% to 35% in FEV₁ and 27% to 44% in forced vital capacity (FVC) [9–13]. After lobectomy, FEV₁ and FVC decrease 12% to 23% and 10% to 30%, respectively [9, 11, 12, 14, 15]. The wide variation is partly explained by variations in methods and how soon after the resection the patients are reinvestigated. Another consideration is the functional status after pulmonary resection. Few researchers have studied the changes in exercise capacity during maximal work after lung resection [9, 10, 12]. Again, the results are conflicting. Markos and associates [9] found a fall in maximal oxygen uptake (O₂-Max) and maximal work rate (WR-Max) of 27% and 42%, respectively, 3 months after pneumonectomy, and 13% and 2% after lobectomy. The changes in WR-Max are not correlated to the changes in O₂-Max. Corris and associates [10] found a fall in O₂-Max of 23% 4 months after pneumonectomy, and Pelletier and coworkers [12] found a fall in WR-Max of 12% and 26% from 29 to 200 days after lobectomy and pneumonectomy, respectively.

The purpose of this study was to describe the postoperative alterations in both lung function and exercise capacity after lung resection for lung carcinoma.

	Material and Methods

Top Footnotes Abstract Introduction Material and Methods Patients Resting Lung Function Arterial Blood Gas Analysis Exercise Test Statistics Results Comment Acknowledgments References

 
All patients scheduled to have lung resection were prospectively, consecutively examined with a maximal ramp exercise test, spirometry, and measurements of arterial gas tensions at rest. Patients free of metastatic disease were reinvestigated by identical methods and equipment 6 months postoperatively.

	Patients

Top Footnotes Abstract Introduction Material and Methods Patients Resting Lung Function Arterial Blood Gas Analysis Exercise Test Statistics Results Comment Acknowledgments References

 
During a period of 32 months 97 consecutive patients with proven or suspected lung malignancy considered to be surgically resectable on the basis of clinical investigation, chest roentgenography, and bronchoscopy, were included. Of these patients, 40 patients were not reinvestigated for the following reasons: 18 patients were found to have unresectable disease during the operation, 14 patients died within 6 months, 5 had progressive metastatic disease at the time of follow-up and could not participate in exercise testing, and 3 patients refused further investigation. The study was then performed on the basis of 57 resected patients, in whom we were able to repeat the dynamic spirometry and maximum exercise test after 6 months. There were 41 men and 16 women. All had non–small cell carcinoma. No patients were receiving radiation therapy. Sixteen had a pneumonectomy (median age, 59 years; range, 45 to 74 years). Of the 41 patients with lobectomies (median age 67 years; range, 38 to 79 years), 34 patients had simple lobectomy and 7 patients had bilobectomy.

No postoperative rehabilitation or training was provided for the patients.

	Resting Lung Function

Top Footnotes Abstract Introduction Material and Methods Patients Resting Lung Function Arterial Blood Gas Analysis Exercise Test Statistics Results Comment Acknowledgments References

 
The FEV₁, vital capacity, and FVC were measured (Vitalograph, Buckingham, UK) in accordance with ATS guidelines. All values obtained were also expressed as percentage of predicted values using standardized prediction formulas [16].

	Arterial Blood Gas Analysis

Top Footnotes Abstract Introduction Material and Methods Patients Resting Lung Function Arterial Blood Gas Analysis Exercise Test Statistics Results Comment Acknowledgments References

 
Arterial blood at rest was analyzed for oxygen and carbon dioxide tensions (ABL4; Radiometer, Copenhagen, Denmark).

	Exercise Test

Top Footnotes Abstract Introduction Material and Methods Patients Resting Lung Function Arterial Blood Gas Analysis Exercise Test Statistics Results Comment Acknowledgments References

 
A multistage ramp, 10- to 15-W/min, maximal exercise protocol was performed in the upright position on an electrically braked cycle ergometer (Medgraphics CPE 2000; Medical Graphics Corporation, MN). Subjects breathed through a low-resistance, low dead-space (100 mL) valve (Hans Rudolph). The following variables were determined throughout the test: WR (W), O₂ (mL/min, standard temperature and pressure–dry), carbon dioxide production (mL/min, standard temperature and pressure–dry), ventilation (L/min, body temperature pressure saturated), heart rate (beats/min), capillary saturation (%), and blood pressure (mm Hg). All patients were monitored with a 12-lead electrocardiogram during exercise tests. Hard copies were collected at rest, every minute during work, at maximum exercise, and when arrhythmias or other electrocardiographic changes occurred. Anaerobic threshold corresponding to the O₂-max in mL/min was estimated using the V-slope method [17]. The respiratory gas exchange variables were determined on-line using a computer-controlled system (Medical Graphics Corporation 2001) with the cycle ergometer interfaced to the computer and constant feedback on the power output. Data were automatically collected breath-by-breath and the average of eight breaths was reported. Results were compared with predicted values [18].

Patients were asked to refrain from heavy work, smoking, and drinking coffee or tea on the day of exercise test. Patients exercised to exhaustion, or to occurrence of predefined stop criteria: severe angina pectoris; systolic blood pressure greater than 240 mm Hg or blood pressure drop exceeding 20 mm Hg; or capillary saturation less than 80% [19]. Patients indicated the reason for stopping. Confirmation of maximal exercise was assessed by failure of O₂ to increase despite further increase in WR, and by a respiratory exchange ratio (CO₂ production/O₂) greater than 1.09 [19].

The pneumotachograph and gas analyzers were calibrated before each test. The relative humidity, ambient temperature, and barometric pressure were registered and entered. The pneumotachograph was calibrated against a 3.0-L syringe (Hans Rudolph 5530). Gas analyzers were calibrated as a two-point calibration against a commercially available gas mixture (14.0% O₂, 6.0% CO₂) and ambient air.

	Statistics

Top Footnotes Abstract Introduction Material and Methods Patients Resting Lung Function Arterial Blood Gas Analysis Exercise Test Statistics Results Comment Acknowledgments References

 
Differences between reinvestigated patients and those who were not reinvestigated were analyzed with a two-sample rank sum test (Mann-Whitney) for continuous data, and with Fisher's exact test for categorical data. Within patient changes caused by lung resection were analyzed with Mann-Whitney test for all variables. Changes in different parameters in the pneumonectomy group were compared with corresponding changes in the lobectomy group with Mann-Whitney rank sum test. The relation between changes in different parameters was analyzed with Spearman correlation. A p value less than 0.05 was accepted as the significance limit.

The study was approved by the local Ethical Committee and informed consent was obtained.

	Results

Top Footnotes Abstract Introduction Material and Methods Patients Resting Lung Function Arterial Blood Gas Analysis Exercise Test Statistics Results Comment Acknowledgments References

 
The effect of lung resection on spirometric and exercise values for patients having pneumonectomy and lobectomy are shown in Table 1. Figures 1 and 2 show the range of preoperative and postoperative values and the individual changes for FVC and O₂-Max.

View larger version (16K): [in this window] [in a new window]   Fig 1. . Preoperative and postoperative values of forced vital capacity (FVC, in L) for patients having lobectomy and pneumonectomy are scattered around the line of identity.

View larger version (19K): [in this window] [in a new window]   Fig 2. . Preoperative and postoperative values of maximum oxygen uptake (VO2-Max, mL/min, standard temperature and pressure–dry) for patients having lobectomy and pneumonectomy are scattered around the line of identity.

In patients having pneumonectomy, FEV₁ and FVC decreased significantly, 23% and 27%, respectively. In this group the loss in lung volume was partly compensated as measured by exercise capacity. Thus, O₂-Max and WR-max decreased only 16% (Table 1), which was significantly less than the decrease in FVC. Ventilation on maximal exercise decreased 19%, and, as in the lobectomy patients, this decline was solely due to a decrease in maximal tidal volume, whereas respiratory rate was unaltered. Thus, pneumonectomy led to a bigger permanent loss in spirometry variables, which was partly functionally compensated, as measured by exercise capacity. Spirometry variables could be said to overestimate the decrease in functional capacity after pulmonary resection.

We divided the patients into two groups according to preoperative pulmonary function: FEV₁-preop above the median (74% predicted) and FEV₁-preop below the median. It appeared that patients with FEV₁-preop below the median had a lower postoperative fall in FVC compared with the patients with FEV₁-preop above the median (8.2% versus 20.1%; p < 0.05 by Mann-Whitney test). Five patients had a FEV₁-preop less than 50% predicted, and 4 of these patients actually increased their postoperative FVC.

Preoperative profiles in pulmonary function showed an obstructive pattern (FEV₁/FVC ratio less than 0.7) in half the patients (51%). This remained unchanged after resection.

The correlation between alterations in O₂-Max and FVC after resection are depicted in Figure 3. Though statistically significant, we only found a weak relation (r = 0.42; p = 0.002) between changes in O₂-Max and FVC. The relation between changes in WR-Max and FVC was even weaker (r = 0.25; p = 0.06). Again, this gives an impression that the changes in the functional related variable, O₂-Max, are different from the changes in the lung volume variable, FVC.

View larger version (23K): [in this window] [in a new window]   Fig 3. . Correlation between alterations in maximal oxygen uptake (VO2-Max, % preoperatively) and alterations in forced vital capacity (FVC, % preoperatively) after pneumonectomy and lobectomy.

	Comment

Top Footnotes Abstract Introduction Material and Methods Patients Resting Lung Function Arterial Blood Gas Analysis Exercise Test Statistics Results Comment Acknowledgments References

 
In patients with bronchogenic carcinoma the extent of pulmonary resection necessary to accomplish radical extirpation of the tumor is difficult to predict, and before the operation it is necessary to evaluate the pulmonary point of origin and the predicted postoperative values. Measurements of postoperative spirometric values after pneumonectomy and lobectomy vary considerably. Most consistent are the measurements after pneumonectomy with deterioration of 29% to 35% in FEV₁ [9–12, 20] and 27% to 44% in FVC [9–11]. After lobectomy the findings are more varied with a fall in FEV₁ of 12% to 23% [9, 11, 12, 14] and in FVC of 10% to 30% [9, 11, 14, 15]. These differences are partly explained by variations in methods, disease in the investigated patients, and time point of analysis after resection. The fall in FEV₁ and FVC are less than expected from the number of resected segments, which is explained by the fact that the neoplasm already preoperatively causes a reduction in lung function. This is confirmed by scintigraphy studies [9, 10, 20–23]. Few have studied the changes after lung resection in exercise capacity during maximal work [9, 10, 12]. Again the results are conflicting. Markos and associates [9] found a fall in O₂-Max and WR-Max of 27% and 42%, respectively, 3 months after pneumonectomy, and 13% and 2% after lobectomy. This pattern is in itself conflicting because the decrease in O₂-Max would be expected to follow the decrease in WR-Max. Corris and associates [10] found a fall in O₂-Max of 23% 4 months after pneumonectomy and Pelletier and colleagues [12] found a fall in WR-Max of 12% and 26% from 26 to 200 days after lobectomy and pneumonectomy, respectively. Generally the reports do not satisfactorily account for the selection of patients. Some reports are publishing data on the same number of patients preoperatively and 3 to 4 months postoperatively. There is no information given on the number of patients dying in this period. Several factors may affect the results of the repeated lung function studies apart from the resection of lung tissue itself.

In this study we chose not to reinvestigate our patients before 6 months postoperatively to minimize the influence of pain and atelectasis on performance after thoracotomy and achieve full pulmonary compensation after lung resection. The findings at 6 months postoperatively are probably close to the permanent functional capacity. We used objective parameters in the assessment of the patients attempting to reach actual maximum exercise level. All patients were exercised maximally. Spirometric and exercise values decreased significantly after lung resection. In patients having pneumonectomy the fall in exercise capacity was less than the loss of lung volume. Thus, the loss of volume is partly compensated by better oxygen uptake. This finding is consistent with previous studies showing a structural change with hyperplasia rather than hyperinflation after lung resection [24, 25]. We observed a weak correlation between the changes in spirometric variables and changes in exercise variables. In some patients exercise capacity increased or barely changed even though they lost 30% to 35% of the ventilatory capacity (Fig 3); in other patients the ventilatory capacity inversely increased 20% to 25% though exercise capacity decreased 0% to 20%. Then again, some patients increased in both pulmonary function and exercise values. These circumstances could be related to surgical removal of diseased airways, alteration in ventilation/perfusion mismatch, or change in smoking habits. We know now from surgery on patients with chronic obstructive lung disease that removal of emphysematous parts of the lungs can improve elastic properties of the remaining tissue. Some of the lack of decline in exercise values in the pneumonectomy patients could also be related to improved oxygen uptake in the muscles during the 6-month period. We found no changes in weight (73.3 versus 72.7 kg) or body mass index (24.5 versus 24.2 kg/m²) after resection.

The sample size in the lobectomy group (n = 41) ensures an 80% chance of finding a difference of approximately 12% or more in FEV₁%, assuming a type 1 error of 0.05 and a type 2 error of 0.2 calculated by using the actual achieved standard deviation [26]. Thus, the fact that the decrease in FEV₁ of 8% did not achieve significance possibly reflects a beta error.

The lobectomy group consisted of patients with different degrees of resection; thus, both patients having simple lobectomy and patients having bilobectomy were included in this group. There were, however, no significant differences between patients having simple lobectomy and patients having bilobectomy, and the two groups were thus analyzed together.

In 12 patients with bronchogenic carcinoma we investigated the reproducibility of maximal exercise tests [27]. The within subject variability of O₂-Max, maximal CO₂ production, and maximal ventilation was found to be less than 4% in two consecutive tests with an interval of 7 days.

In conclusion, lobectomy is very well tolerated and is associated with only minor deterioration of lung function and exercise capacity. Pneumonectomy causes a decrease in pulmonary volumes to about 75% of the preoperative values, but this loss of volume is partly compensated by better oxygen uptake, which postoperatively was about 85% of the preoperative values. Generally patients with the smallest preoperative FVC had the smallest postoperative deterioration expressed in percentages. Change in FEV₁ is a poor predictor of change in exercise capacity after pulmonary resection.

	Acknowledgments

Top Footnotes Abstract Introduction Material and Methods Patients Resting Lung Function Arterial Blood Gas Analysis Exercise Test Statistics Results Comment Acknowledgments References

 
This study was supported by grants from Velux, Foersom, and Hartmanns Foundations, Denmark.

	Footnotes

Top Footnotes Abstract Introduction Material and Methods Patients Resting Lung Function Arterial Blood Gas Analysis Exercise Test Statistics Results Comment Acknowledgments References

 
Address reprint requests to Dr Larsen, Fossgardsvej 34, DK-2720 Vanlose, Denmark.

	References

Top Footnotes Abstract Introduction Material and Methods Patients Resting Lung Function Arterial Blood Gas Analysis Exercise Test Statistics Results Comment Acknowledgments References

 

1. Drings P, Vogt-Moykopf I. Pre-operative assessment of patients undergoing surgery for bronchial carcinoma. Eur Soc Pneumol 1986;10:7–11.
2. Zibrak JD, O'Donnel CR, Marton K. Indications for pulmonary function testing. Ann Intern Med 1990;112:763–71.[Medline]
3. Marshall MC, Olsen GN. The physiologic evaluation of the lung resection candidate. Clin Chest Med 1993;14:305–19.[Medline]
4. Gilbreth EM, Wiesman IM. Role of exercise stress testing in preoperative evaluation of patients for lung resection. Clin Chest Med 1994;15:389–403.[Medline]
5. Dunn WF, Scanlon PD. Preoperative pulmonary function testing for patients with lung cancer. Mayo Clin Proc 1993;68:371–7.[Medline]
6. Anderson R, Arentzen C. Carcinoma of the lung. Surg Clin North Am 1980;60:793–814.[Medline]
7. Boysen PG, Harris JO, Block AJ, Olsen GN. Prospective evaluation for pneumonectomy using perfusion scanning: follow-up beyond one year. Chest 1981;80:163–6.[Abstract/Free Full Text]
8. Drings P. Preoperative assessment of lung cancer. Chest 1989;96:42S–4S.
9. Markos J, Mullan BP, Hillman DR, et al. Preoperative assessment as a predictor of mortality and morbidity after lung resection. Am Rev Respir Dis 1989;139:902–10.[Medline]
10. Corris PA, Ellis DA, Hawkins T, Gibson GJ. Use of radionuclide scanning in the preoperative estimation of pulmonary function after pneumonectomy. Thorax 1987;42:285–91.[Abstract/Free Full Text]
11. Van Mieghem W, Demedts M. Cardiopulmonary function after lobectomy or pneumonectomy for pulmonary neoplasm. Respir Med 1989;83:199–206.[Medline]
12. Pelletier C, Lapointe L, LeBlanc P. Effects of lung resection on pulmonary function and exercise capacity. Thorax 1990;45:497–502.[Abstract/Free Full Text]
13. Dunn E, Hernandez J, Bender H, Prager R. Alterations in pulmonary function following pneumonectomy for bronchogenic carcinoma. Ann Thorac Surg 1982;34:176–80.[Abstract]
14. Nishimura H, Haniuda M, Morimoto M, Kubo K. Cardiopulmonary function after pulmonary lobectomy in patients with lung cancer. Ann Thorac Surg 1993;55:1477–84.[Abstract]
15. Berend N, Woolcock A, Marlin G. Effects of lobectomy on lung function. Thorax 1980;35:145–50.[Abstract/Free Full Text]
16. Danish Society of Respiratory Medicine. Spirometry. A recommendation, 1st ed. Copenhagen: Nationalforeningen, 1986:9.
17. Beaver WL, Wasserman K, Whipp BJ. A new method for detecting the anaerobic threshold by gas exchange. J Appl Physiol 1986;60:2020–7.[Abstract/Free Full Text]
18. Wasserman K, Hansen J, Sue D, Whipp B, eds. Principles of exercise testing and interpretation, 1st ed. Philadelphia: Lea & Febiger, 1987:73.
19. Zavala DC, ed. Manual on exercise testing; a training handbook, 1st ed. Iowa: Press of The University of Iowa, 1987:38.
20. Ali MK, Ewer MS, Atallah MR, et al. Regional and overall pulmonary function changes in lung cancer. Correlations with tumor stage, extent of pulmonary resection, and patient survival. J Thorac Cardiovasc Surg 1983;86:1–8.[Abstract]
21. Cordiner A, De Carlo F, De Gennaro R, Pau F, Flore F. Prediction of postoperative pulmonary function following thoracic surgery for bronchial carcinoma. Angiology 1991;42:985–9.[Abstract/Free Full Text]
22. Olsen GN, Block AJ, Tobias JA. Prediction of postpneumonectomy pulmonary function using quantitative macroaggregate lung scanning. Chest 1974;66:13–6.[Abstract/Free Full Text]
23. Wernly JA, DeMeester TR, Kirchner PT, Myerowitz PD, Oxford DE, Golomb HM. Clinical value of quantitative ventilation-perfusion lung scans in the surgical management of bronchogenic carcinoma. J Thorac Cardiovasc Surg 1980;80:535–43.[Medline]
24. Burri PH, Sehovic S. The adaptive response of the rat lung after bilobectomy. Am Rev Respir Dis 1979;119:769–77.[Medline]
25. Cowan M, Crystal RG. Lung growth after unilateral pneumonectomy: quantification of collagen synthesis and content. Am Rev Respir Dis 1975;111:267–77.[Medline]
26. Young MJ, Bresnitz EA, Strom BL. Sample size nomograms for interpreting negative clinical studies. Ann Intern Med 1983;99:248–51.[Medline]
27. Larsen KR, Milman N, Svendsen U, Petersen BN. Reproducibility of gas exchange and respiratory parameters in a modern exercise testing devise. Eur Resp J 1995;8(Suppl 19):244s.

This article has been cited by other articles:

				K. Kushibe, T. Kawaguchi, M. Kimura, M. Takahama, T. Tojo, and S. Taniguchi Exercise capacity after lobectomy in patients with chronic obstructive pulmonary disease Interactive CardioVascular and Thoracic Surgery, June 1, 2008; 7(3): 398 - 401. [Abstract] [Full Text] [PDF]

				A. Brunelli, F. Xiume, M. Refai, M. Salati, R. Marasco, V. Sciarra, and A. Sabbatini Evaluation of Expiratory Volume, Diffusion Capacity, and Exercise Tolerance Following Major Lung Resection: A Prospective Follow-up Analysis Chest, January 1, 2007; 131(1): 141 - 147. [Abstract] [Full Text] [PDF]

				J.-S. Wang, R. T. Abboud, and L.-M. Wang Effect of lung resection on exercise capacity and on carbon monoxide diffusing capacity during exercise. Chest, April 1, 2006; 129(4): 863 - 872. [Abstract] [Full Text] [PDF]

				A. Bobbio Reply to Ferri et al. Eur. J. Cardiothorac. Surg., February 1, 2006; 29(2): 267 - 267. [Full Text] [PDF]

				A. Bobbio, A. Chetta, P. Carbognani, E. Internullo, A. Verduri, G. Sansebastiano, M. Rusca, and D. Olivieri Changes in pulmonary function test and cardio-pulmonary exercise capacity in COPD patients after lobar pulmonary resection Eur. J. Cardiothorac. Surg., November 1, 2005; 28(5): 754 - 758. [Abstract] [Full Text] [PDF]

				A. E. Martin-Ucar, A. Nakas, J. E. Pilling, K. J. West, and D. A. Waller A case-matched study of anatomical segmentectomy versus lobectomy for stage I lung cancer in high-risk patients Eur. J. Cardiothorac. Surg., April 1, 2005; 27(4): 675 - 679. [Abstract] [Full Text] [PDF]

				S. A. Smulders, F. W. J. M. Smeenk, M. L. G. Janssen-Heijnen, and P. E. Postmus Actual and Predicted Postoperative Changes in Lung Function After Pneumonectomy: A Retrospective Analysis Chest, May 1, 2004; 125(5): 1735 - 1741. [Abstract] [Full Text] [PDF]

				A. Toker, S. Dilege, S. Ziyade, O. Eroglu, S. Tanju, D. Yilmazbayhan, Z. Kilicarslan, and G. Kalayci Causes of death within 1 year of resection for lung cancer. Early mortality after resection Eur. J. Cardiothorac. Surg., April 1, 2004; 25(4): 515 - 519. [Abstract] [Full Text] [PDF]

				L. Sarna, L. Evangelista, D. Tashkin, G. Padilla, C. Holmes, M. L. Brecht, and F. Grannis Impact of Respiratory Symptoms and Pulmonary Function on Quality of Life of Long-term Survivors of Non-Small Cell Lung Cancer Chest, February 1, 2004; 125(2): 439 - 445. [Abstract] [Full Text] [PDF]

				J. R. Handy Jr, J. W. Asaph, L. Skokan, C. E. Reed, S. Koh, G. Brooks, E. C. Douville, A. C. Tsen, G. Y. Ott, and G. A. Silvestri What Happens to Patients Undergoing Lung Cancer Surgery?* : Outcomes and Quality of Life Before and After Surgery Chest, July 1, 2002; 122(1): 21 - 30. [Abstract] [Full Text] [PDF]

				C. N. Foroulis, C. Kotoulas, M. Konstantinou, and A. Lioulias Is the reduction of forced expiratory lung volumes proportional to the lung parenchyma resection, 6 months after pneumonectomy? Eur. J. Cardiothorac. Surg., May 1, 2002; 21(5): 901 - 905. [Abstract] [Full Text] [PDF]

				A. Brunelli, M. Monteverde, M. Salati, A. Borri, M. Al Refai, and A. Fianchini Stair-climbing test to evaluate maximum aerobic capacity early after lung resection Ann. Thorac. Surg., November 1, 2001; 72(5): 1705 - 1710. [Abstract] [Full Text] [PDF]

				S. Cykert, G. Kissling, and C. J. Hansen Patient Preferences Regarding Possible Outcomes of Lung Resection : What Outcomes Should Preoperative Evaluations Target? Chest, June 1, 2000; 117(6): 1551 - 1559. [Abstract] [Full Text] [PDF]

				A. Carretta, P. Zannini, A. Puglisi, G. Chiesa, A. Vanzulli, A. Bianchi, A. Fumagalli, and S. Bianco Improvement of pulmonary function after lobectomy for non-small cell lung cancer in emphysematous patients Eur. J. Cardiothorac. Surg., May 1, 1999; 15(5): 602 - 607. [Abstract] [Full Text] [PDF]

				J. Kowalewski, M. Brocki, T. Dryjanski, K. Kapron, and S. Barcikowski Right ventricular morphology and function after pulmonary resection Eur. J. Cardiothorac. Surg., April 1, 1999; 15(4): 444 - 448. [Abstract] [Full Text] [PDF]

				A-M Nugent, I C Steele, A M Carragher, K McManus, J A McGuigan, J R P Gibbons, M S Riley, and D P Nicholls Effect of thoracotomy and lung resection on exercise capacity in patients with lung cancer Thorax, April 1, 1999; 54(4): 334 - 338. [Abstract] [Full Text]

This Article Abstract Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Larsen, K. R. Articles by Petersen, B. N. Search for Related Content PubMed PubMed Citation Articles by Larsen, K. R. Articles by Petersen, B. N.