Unsuspected lung cancer found in work-up for lung reduction operation

Background. Lung reduction surgery is gaining acceptance in the treatment of patients suffering from severe diffuse emphysema. At the University of Pittsburgh 210 patients have been evaluated and 128 patients have undergone lung reduction operations. Methods. Ten patients, representing 7.8% of the operated group, have had asymptomatic cancerous or neoplastic lesions diagnosed on preoperative evaluation or pathologic analysis of resected tissue. Results. Six primary lung cancers (three squamous, three adenocarcinoma) and four other neoplastic lesions (squamous dysplasia, chemodectoma, and two carcinoid tumorlets) have been identified. All patients were heavy smokers, and all had markedly impaired pulmonary function. Patients whose lesions were identified on preoperative testing underwent thoracoscopic wedge excision of the tumor alone. Conclusions. Our experience suggests that patients with impaired pulmonary function (chronic obstructive pulmonary disease) presenting for lung reduction operations are at a high risk of harboring an unsuspected neoplastic lesion. Complete preoperative evaluation of radiographic studies and preoperative bronchoscopic examination are mandatory.