Lung Resection for Non-Small Cell Lung Cancer following Bronchoscopic Lung Volume Reduction for Heterogenous Emphysema

TL;DR

This study shows that lung cancer surgery can be safely performed after a minimally invasive procedure improves lung function in patients with emphysema.

Contribution

Demonstrates the feasibility of lung cancer resection following bronchoscopic lung volume reduction in patients with emphysema.

Findings

BLVR significantly improved pulmonary function metrics like FEV1, FVC, and DLCO.

Lung cancer surgery after BLVR was safe with no major complications or cancer relapses.

Median survival was 35 months with preserved lung function post-surgery.

Abstract

In patients with pulmonary emphysema and NSCLC, poor respiratory function may contraindicate surgical resection. Bronchoscopic lung volume reduction (BLVR) is a minimally invasive procedure for management of emphysema associated with improvement in pulmonary function and quality of life. Therefore, we aimed to evaluate the feasibility of lung resection for NSCLC after BLVR. The improvement in pulmonary function obtained with BLVR may allow nonsurgical candidates to undergo lung resection for lung cancer.

Bronchoscopic lung volume reduction (BLVR) is a minimally invasive treatment for emphysema. Lung cancer may be associated with emphysema due to common risk factors. Thus, a growing number of patients undergoing BLVR may develop lung cancer. Herein, we evaluated the effects of lung resection for non-small cell lung cancer in patients undergoing BLVR. The clinical data of patients undergoing BLVR followed by lung resection for NSCLC were retrospectively reviewed. For each patient, surgical and oncological outcomes were recorded to define the effects of this strategy. Eight patients were included in our series. In all cases but one, emphysema was localized within upper lobes; the tumor was detected during routine follow-up following BLVR and it did not involve the treated lobe. The comparison of pre- and post-BLVR data showed a significant improvement in FEV1 (29.7 ± 4.9 vs. 33.7 ± 6.7, p = 0.01); in FVC (28.5 ± 6.6 vs. 32.4 ± 6.1, p = 0.01); in DLCO (31.5 ± 4.9 vs. 38.7 ± 5.7, p = 0.02); in 6MWT (237 ± 14 m vs. 271 ± 15 m, p = 0.01); and a reduction in RV (198 ± 11 vs. 143 ± 9.8, p = 0.01). Surgical resection of lung cancer included wedge resection (n = 6); lobectomy (n = 1); and segmentectomy (n = 1). No major complications were observed and the comparison of pre- and post-operative data showed no significant reduction in FEV1% (33.7 ± 6.7 vs. 31.5 ± 5.3; p = 0.15) and in DLCO (38.7 ± 5.7 vs. 36.1 ± 5.4; p = 0.15). Median survival was 35 months and no cancer relapses were observed. The improved lung function obtained with BLVR allowed nonsurgical candidates to undergo lung resection for lung cancer.

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