Treatment of patients with lung cancer and severe emphysema.

The development of lung cancer and emphysema is associated with the destructive chemical milieu that occurs with smoking. The recent interest in lung volume reduction surgery (LVRS) has stimulated a reassessment of the indications for surgery in patients with early stage lung cancer or emphysema. For patients with both diseases, the issues surrounding LVRS are simplified. The major concern is that the lung cancer can be surgically removed without the need for postoperative ventilation or mortality. A secondary consideration is the potential for long-term postoperative respiratory morbidity. These risks can be estimated by evaluating the anatomic location of the tumor, as well as the physiology of the underlying emphysema. Early results of combined LVRS and lung cancer resections suggest a favorable outcome in carefully selected patients.