Perioperative management of a morbidly obese patient undergoing right upper lobectomy with poor pulmonary function: a case report

Abstract

The incidence and prevalence of obesity is drastically increasing worldwide. Clinical surgeons treating cancer patients often encounter obese patients. However, cases of surgical lung cancer patients with morbid obesity and poor pulmonary function undergoing lobectomy have not been reported. A 75-year-old woman was referred to our hospital on June 25, 2014 with a cough with blood in phlegm for 1 week. Staging positron emission tomography revealed an abnormal lesion indicating malignancy under the pleura of the upper lobe of the right lung. As the patient had chronic obstructive pulmonary disease (COPD) and was morbidly obese [body mass index (BMI): 40.1 kg/m2], she had preoperative poor pulmonary function with a forced expiratory volume in 1s (FEV1) of 1.06l and diffusing lung capacity for carbon monoxide of 52.2. After 2 weeks of rehabilitation and treatment, respiratory function improved before surgery. The patient required thoracotomy so that right upper lobectomy with lymph node dissection under general anesthesia could be performed. However, on postoperative day 3, the patient was diagnosed with postoperative severe pneumonia with respiratory failure and cardiac insufficiency, and was transferred to the intensive care unit (ICU). After 72 postoperative days, the patient was discharged from hospital. The pathological diagnosis was invasive adenocarcinoma. Although the patient experienced severe postoperative complications, this case is useful for surgeons treating cancer patients because there are few reports discussing the perioperative management of morbidly obese patients with poor pulmonary function undergoing lung cancer radical resection. Further studies on lobectomy for morbidly obese lung cancer patients with poor pulmonary function are warranted to improve the treatment methods of these patients.