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To describe and compare the daily ambulatory activity of the patients before and one month after major lung resection. Daily activity was measured using a pedometer (OMROM Walking Style PRO) given preoperatively in a prospective way to a series of 21 consecutive cases scheduled for lobectomy or pneumonectomy. Analyzed variables were age, pulmonary function, mean number of total and aerobic steps per day, walked distance and mean daily time of aerobic activity. Activity variables were analyzed individually and as a new differential variable DELTA. Wilcoxon and Mann-Whitney nonparametric tests were used for comparison between groups. General series data: 19 male. Age: 63+/-10.9 years. FEV(1)%: 88.4+/-22.7. DLCO: 86.2+/-21.6. Eleven cases had COPD criteria. Type of surgery: 3 pneumonectomy/18 lobectomy. Activity data: all patients showed a global decrease of their activity one month after surgery but, patients in the pneumonectomy group are unable to keep aerobic activity meanwhile patients that undergone lobectomy showed only a 25% reduction in the measured variables. Major pulmonary resection decreases the time and the quality of the daily ambulatory activity of the patients during the first postoperative month. Despite limitations, the chosen pedometer OMRON Walking Style Pro is an efficient tool to evaluate the perioperative daily ambulatory activity of patients.

We review our experience in the treatment of complex large chest-wall defects needing a multidisciplinary approach due to primary or secondary neoplasms. Non-small cell lung cancer with chest-wall invasion cases are excluded. Fifteen patients underwent whole thickness resection of the chest wall due to lesions affecting at least three ribs, sternum, clavicle or thoracic spine and the surrounding soft tissue. Previously operated breast cancer and sarcoma were the most frequent diagnoses. Partial or total sternectomy plus rib resection was performed in 8 patients. Immediate closure of the defects was performed in all cases: 12 with single prosthesis placement and 3 with a rigid one of methylmethacrylate. Coverage was achieved using myocutaneous flaps in most cases and, in one case, using the greater omentum that supported a free split-thickness skin graft. No 30-days mortality was recorded. Three patients had a post-operative complication. Mean hospital stay was 11.7+/-9 days. All cases of primary tumours were alive at the time of review (range: 6-126 months). In conclusion, resection and immediate reconstruction of large chest wall defects can be accomplished without operative mortality and low morbidity whenever close cooperation between plastic and thoracic teams exists.

The aim of this study is to evaluate the concordance between predicted postoperative forced expiratory volumes in 1s (ppoFEV1) calculated on the basis of data known before surgery with ppoFEV1 calculated after completing surgical procedure. We have prospectively studied 66 consecutive patients (55 cases scheduled for lobectomy and 11 for pneumonectomy) operated on for bronchial carcinoma. According to location, 33 tumours were classified as central and 33 as peripheral. In all cases, ppoFEV1 was calculated twice: first (ppoFEV1-A) according to the scheduled surgical procedure; second (ppoFEV1-B) according to the procedure eventually performed. At operation, 43 lobectomies (65.2%) and 23 pneumonectomies (34.8%) were performed. Differences between ppoFEV1 A and B were found in 18 cases (12 central tumours). In three of them (4.5% of 66 cases), ppoFEV1-B was under 40%. Pearson coefficient was 0.85 (P<0.001) for the whole series of cases; 0.83 (P<0.001) for central and 0.87 (P<0.001) for peripheral tumours. On multiple regression analysis, R2 was 0.76 and ppoFEV1-A had the highest influence on the dependent variable. We have found that: (1) there is no perfect correlation between ppoFEV1 calculated with data known before and after surgery; (2) discrepancies are most important in centrally located tumours and (3) in 4.5% of cases, discrepancies could have influenced the preoperative risk estimation.

Reconstruction after large chest wall resections must ensure not only anatomical coverage but a normal respiratory function, specially in the case of associated ventilatory disturbance. Since prosthetic reconstruction can present some problems such as rejection, excessive rigidity or infection, bone grafts have been proposed as an alternative to synthetic materials, due to their effectiveness and capability of integration with host tissues. Although iliac bone allograft or autologous ribs harvested from the opposite operative side are described for reconstruction, we present here the first reported clinical case of donor cryopreserved rib allografts use after extensive chest wall resection in a patient with severe COPD, showing excellent short-term results in the absence of pulmonary function impairment.