Thoracoscopic surgery for lung cancer complicated by emphysema in elderly patients. Report of three cases.

We have experienced three elderly cases who underwent thoracoscopic surgery for lung cancer complicated by emphysema. Cases 1, 2 and 3, respectively aged 76, 78 and 80 years, had required the oxygen therapy preoperatively. Allowing for poor pulmonary reserve, a thoracoscopic partial pulmonary resection for lung cancer combined with Nd-YAG laser pneumoplasty for emphysema was designed. The respective values of forced expiratory volume in one second (FEV 1.0) for cases 1 and 2 increased from 470 and 820 to 860 and 1620 ml. Reductions in residual volumes (RV) for cases 1, 2 and 3 were from 2770, 4940 and 5230 to 2370, 4500 and 3250 ml. The degrees of respiratory failure in the Hugh-Jones classification for cases 1, 2 and 3 were up-graded from V, IV and IV, respectively, to III, II and II, postoperatively. In conclusion, our thoracoscopic treatment, designed for elderly patients with poor pulmonary reserve, allows improvement of emphysema as well as resection of lung cancer.