Quality of Life after Lung Cancer Surgery: A Prospective Study comparing Bronchial Sleeve Lobectomy with Pneumonectomy

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Balduyck Bram, Hendriks Jeroen, Lauwers Patrick, Van Schil Paul

 

UZ Antwerpen, Antwerpen

Objectives: To prospectively evaluate quality of life (QoL) evolution after bronchial sleeve lobectomy and pneumonectomy with the European Organisation for Research and Treatment of Cancer (EORTC) QoL Questionnaire-C30 and LC-13.

Methods: From January 2003 till Decembre 2005, QoL was prospectively recorded after 10 sleeve lobectomies and 20 pneumonectomies. Questionnaires were administered before surgery and 1, 3, 6 and 12 months postoperatively (MPO) with response rates of 100%, 90.0%, 76.7%, 80.0% and 73.3%, respectively.

Results: Sleeve lobectomy was characterized by a one month temporary decrease in physical and social functioning scores after surgery (1MPO p=0.026 and p=0.048, respectively). After sleeve lobectomy, quality of life scores approximated baseline pre-operative values one month after surgery. In the twelve months follow-up period after pneumonectomy, there was no return to baseline in physical and role functioning (12MPO p=0.001 and p=0.011, respectively). Pneumonectomy patients reported a significant increase in postoperative dyspnea (1MPO p=0.027, 6MPO p=0.025, 12MPO 0.021), general pain (1MPO p=0.006, 3MPO p=0.008, 6MPO p=0.005, 12MPO p=0.036), thoracic pain (6MPO p=0.019) and shoulder dysfunction ( 6MPO p=0.04, 12MPO p=0.026). Comparing both resections, significant differences in evolution of physical functioning (1MPO p=0.014, 3MPO p=0.008, 6MPO p=0.004), role functioning (1MPO p=0.041), cognitive functioning (6MPO p=0.005, 12MPO p=0.013) and shoulder dysfunction (12MPO p=0.049) were reported in favor of sleeve lobectomy.

Conclusions: The high burden of dyspnea, general pain, thoracic pain and shoulder dysfunction reported after pneumonectomy, is not seen after sleeve lobectomy. In patients with anatomically appropriate early-stage lung cancer, sleeve lobectomy offers better quality of life than does pneumonectomy.