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Forum Name: Miscellaneous Chest Diseases

Question: Lung removal operation, what to expect


 snakecharmer38 - Wed Jul 28, 2010 8:42 am

I hope someone can give me advice on this as my consultant was pretty vague. I was diagnosed with Bronchectisis in 2000 and Emphysema in 2007. This week I saw my consultant and he was very concerned at how much my lung volume has deteriorated in the past year. To cut a long story short, I am 38 years old and have been in and out of hospital all my life with different chest complaints. The main problem now however is that my right lung is hardly working, keeps getting infected and he is worried that if the infection spreads to the left side ( which it has started ) then my outlook is not good to say the least.
He said to me yesterday that he wants to refer me to a specialist in Bristol to talk about a last ditch effort. He wants me to have an operation to remove the right lung and try to save the other. However he was not too clear with the details, what was said was that obviously my lung capcity will be reduced even further than what it is now but if they can get rid of all the infected areas then my life will be easier.
Thing is though, if that means being on oxygen for the rest of my life then I will have to seriously consider if it will be worth it. I asked him about that, but he says everyone is different and some compensate while others do not.
As for the operation side of it, I would like to know what to expect when I come round as I have not seen the surgeon yet, but its been worrying me.
Yesterday, I had the usual c.t. scan with contrast, lung function, x-rays and blood tests. As I have stated, I have been in hospital numerous times for I.V. treatments with anti-biotics, but the problem they have is that they cannot identify the bugs that are causing the infections. So for the last few years it has been trial and error to see what works. So far though, nothing has which is why he has suggested this operation. Any information would be appreciated, and if you need more details I will try my best to answer. Thanks in advance - James
 Dr.M.Aroon kamath - Sun Aug 15, 2010 11:37 am

User avatar Hi,
Pneumonectomy has perhaps,one of the highest in-hospital mortality rates (5-15%) among common elective surgical procedures.

It is not possible for me to specifically predict how your existing physiology would respond to a pneumonectomy. However, i will let you have some general information about how cases are selected for a pneumonectomy (i have chosen the British Thoracic Society (BTS) and the Society of Cardiothoracic Surgeons of Great Britain and Ireland (SCTS) recommendations for the selection and management of patients with potentially operable lung cancer, as an example).

Basic spirometry: No further respiratory function tests are required for a pneumonectomy if the post-bronchodilator forced expiratory volume in 1 second (FEV1) is >2.0 litres, provided that there is no evidence of interstitial lung disease
or unexpected disability due to shortness of breath.

Step 1:
All patients not clearly operable on the basis of spirometry should have: (a) full pulmonary function tests including estimation of Transfer Factor of the Lung for Carbon Monoxide (TLCO) (b) measurement of oxygen saturation on air at rest; and (c) a quantitative isotope perfusion scan if a pneumonectomy is being considered.These data are used to calculate estimated postoperative FEV1 expressed as % predicted and the estimated postoperative TLCO expressed as % predicted, using either the lung scan

Step 2:
(a) Estimated postoperative FEV1 >40% predicted and estimated postoperative TLCO >40% predicted and oxygen saturation (SaO2) >90% on air: considered average risk.
(b) Estimated postoperative FEV1 <40% predicted and estimated postoperative TLCO <40% predicted: considered high risk.
(c) All other combinations: consider exercise testing.
Patients for whom the risk of resection is still unclear after step 2 tests, should be referred for exercise testing.

Step 3:
(a) A best distance on two shuttle walk tests of <25 shuttles (250 m) or desaturation during the test of more than 4% SaO2: is a high risk for surgery.
(b) Other patients should be referred for a formal cardiopulmonary exercise test. On cardiopulmonary exercise testing, a peak oxygen consumption (V~O2peak) of more than 15 ml/kg/min indicates an average risk for surgery.
(c) A V~O2peak of <15 ml/kg/min indicates a high risk for surgery.

I will leave out detailed discussion on assessment of cardiac risk except to say that as a rough estimate, patients who have an exercise tolerance > 4 metabolic equivalents (METS) (can climb 1 flight of stairs) do not need further cardiac investigation(the exceptions are the elderly).
I hope this information may be helpful.
Best wishes!

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