Bilateral pneumectomy for emphysema: Anatomic correlation with Computed Tomography (CT) scan, ventilation-perfusion (V/Q) scan, and surgically resected lung as a predictor of short term functional outcome

Purpose: To compare operative anatomy of lung removed for emphysema with preoperative CT and V/Q localization and to correlate these results with 3 month postoperative lung function as a predictor of outcome. Methods: Retrospective review of 9 bilateral pneumectomy cases performed between February and December, 1995. Pre-operative CT scans, V/Q scans, and operative notes were reviewed. Correlation between CT and V/Q findings and anatomic location of resected lung at operation were compared. Three month post-operative spirometry, lung volumes, DLCO, and 6 minute walk distance were then evaluated and the results compared to preoperative values and correlated with anatomic findings. Results: In 7 patients, operative anatomy correlated with CT and V/Q localization. All 7 showed an improvement in most parameters. In 2 patients operative anatomy did not correlate with CT and/or V/Q localization. These snowed similar improvement in spirometry and lung volumes, however, DLCO and 6 minute walk distance were decreased. Conclusions: Anatomic correlation between CT scan, V/Q scan, and surgical localization predicts an increase in DLCO and 6 minute walk distance at 3 month follow up compared to pre-operative levels. When anatomic correlation does not exist, despite comparable improvement in spirometry and lung volumes, DLCO and 6 minute walk distance are adversely effected. Clinical Implications: Areas of resection during bilateral pneumectomy for emphysema should correlate with CT and V/Q scans in order to achieve the best results.