From the Guidelines
Vital capacity does decrease significantly after a right upper lobectomy, with patients experiencing a reduction of approximately 9-11% in their FEV1 by 6 months postoperatively, as reported by 1. This reduction occurs because the surgery permanently removes functional lung tissue, decreasing the overall volume available for gas exchange. The degree of functional impairment varies based on preoperative lung function, age, smoking history, and presence of underlying lung disease. Some key factors to consider include:
- The right upper lobe contributes to total lung function, so its removal directly impacts the total volume of air a person can exhale after maximum inspiration.
- The remaining lung tissue often undergoes compensatory hyperinflation over time, which may partially offset this loss.
- Most patients adapt to this change through pulmonary rehabilitation, which includes breathing exercises and physical conditioning to optimize the function of remaining lung tissue. Despite the reduction in vital capacity, many patients maintain adequate respiratory function for normal daily activities after recovery, although some may experience limiting symptoms such as dyspnea or leg discomfort, as noted in 1. It's also important to consider that the predicted postoperative FEV1 is a key parameter in predicting postoperative complications after resection, with mortality rates increasing when the predicted postoperative FEV1 is <40% pred, as reported by 1. However, individual patient factors and overall health status also play a crucial role in determining outcomes after lung resection surgery.
From the Research
Vital Capacity Changes After Right Upper Lobectomy
- The study 2 found that right upper lobectomy (RUL) was associated with significantly less loss in forced vital capacity (FVC) than right lower lobectomy (RLL) or left lower lobectomy (LLL).
- Another study 3 reported a mean postoperative decrease in vital capacity (VC) of 10.5% in patients who underwent right upper lobectomy.
- A prospective study 4 found that vital capacity (VC) was higher at 12 months than at 3 months after right upper lobectomy (RUL) or right lower lobectomy (RLL).
- The study 5 assessed changes in pulmonary function in terms of 'volume reduction effect' after lobectomy for lung cancer and found that upper lobectomy might have the same effect as lung volume reduction surgery.
- The research 6 evaluated the lung volume changes depending on the resected lobes and found that forced vital capacity (FVC) decreased to 11.94% after upper lobectomy, whereas it decreased to 3.07% after lower lobectomy.
Comparison of Vital Capacity Changes
- The studies 2, 3, 4, 5, 6 suggest that the change in vital capacity after right upper lobectomy varies, with some studies reporting a significant decrease and others reporting a less significant decrease or even an increase in vital capacity.
- The decrease in vital capacity after right upper lobectomy is generally less than that after right lower lobectomy or left lower lobectomy 2, 6.
- The studies 3, 4 reported that the decrease in vital capacity after right upper lobectomy was around 10-11%, while the study 6 reported a decrease of 11.94%.
Factors Influencing Vital Capacity Changes
- The study 3 found that patients with chronic obstructive pulmonary disease (COPD) exhibited significantly better preservation of forced expiratory volume in one second (FEV1) after lobectomy.
- The research 5 found that patients with a lower preoperative FEV(1.0)% of predicted had a greater 'volume reduction effect' with an increase in FEV(1.0) after upper lobectomy.
- The study 4 found that improvements in pulmonary function and symptoms varied according to the resected lobe.