Quality of life after tailored combined surgery for stage I non–small-cell lung cancer and severe emphysema

Background We analyzed the early and long-term quality of life changes occurring in 16 patients undergoing tailored combined surgery for stage I non–small-cell lung cancer (NSCLC) and severe emphysema. Methods Mean age was 65 ± 5 years. All patients had severe emphysema with severely impaired respiratory function and quality of life. Tumor resection was performed with sole lung volume reduction (LVR) in 5 patients, separate wedge resection in 3 patients, segmentectomy in 2 patients, and lobectomy in 6 patients. A bilateral LVR was performed in 5 patients. Quality of life was assessed at baseline and every 6 months postoperatively by the Short-form 36 (SF-36) item questionnaire. Results Mean follow-up was 44 ± 21 months. All tumors were pathologic stage I. There was no hospital mortality nor major morbidity. Significant improvements occurred for up to 36 months in the general health (p = 0.02) domain and for up to 24 months in physical functioning (p = 0.02), role physical (p = 0.005), and general health (p = 0.01) SF-36 domains. Associated improvements regarded dyspnea index (−1.3 ± 0.6) forced expiratory volume in one second (+0.28 ± 0.2L), residual volume (−1.18 ± 0.5L) and 6-minute-walking test distance (+86 ± 67 m). Actuarial 5-year survival was similar to that of patients with no cancer undergoing LVRS during the same period (68% vs 82%, p = not significant). Conclusions Our study suggests that selected patients with stage I NSCLC and severe emphysema may significantly benefit from tailored combined surgery in terms of long-term quality of life and survival.