Is oxygen supplementation needed after standard pulmonary resection for primary lung cancer?

OBJECTIVE: Theoretically, anatomical pulmonary resection does not cause any shunt effect, and thus it is thought that oxygen (O(2)) supplementation is not necessary after a pulmonary lobectomy or pneumonectomy. Without O(2) supplementation, we have streamlined our postoperative management for pulmonary resection. In the present study, we prospectively assessed our perioperative management for both requirement of O(2) supplementation and postoperative complications. PATIENTS AND METHODS: From April 2003 to March 2005, 89 consecutive patients underwent a pulmonary lobectomy or pneumonectomy for primary lung cancer. Our protocol for perioperative care is as follows: [Preoperative] Smoking cessation longer than 2 weeks before surgery. [Intraoperative] Postero-lateral thoracotomy through the 5th or 6th rib bed. Cutting of the 5th or 6th intercostal nerve before closure of the wound. [Postoperative day (POD) 1] O(2) administration was discontinued in the morning. Ambulation without O(2) supplementation. [POD 2] Removal of an epidural catheter. During the postoperative period, percutaneous monitoring of O(2) saturation was continued. RESULTS: The mean postoperative O(2) saturation of those 89 patients was 97.0% on the POD 1, 96.4% on the POD 2, 96.6% on the POD 3, and 97.5% on the POD 7. Only 3 patients required O(2) therapy after discontinuation of O(2) administration due to non-lethal pulmonary embolism. Depending on the duration of smoking cessation prior to operation, the patients were divided into 4 groups (2 weeks >, 1 month >, 1 month </=, and nonsmokers). Neither the incidence of postoperative complications nor the length of postoperative hospital stay was different among those 4 groups. CONCLUSION: It is suggested that the postoperative O(2) supplementation is not routinely necessary.