Background:We assessed how the severity of chronic obstructive pulmonary disease (COPD) and other comorbidities affect long-term survival after thoracoscopic lung resection for c-stage I non-small cell lung cancer (NSCLC). Results: The cohort comprised 404 patients with NSCLC, of whom 133 were diagnosed with COPD (51 as GOLD 1, 79 as GOLD 2, and 3 as GOLD 3) and 271 were diagnosed without COPD. The 5-year overall survival (OS) rates were 86.0%, 80.2%, and 71.1% for the non-COPD, GOLD 1, and GOLD 2/3 groups, respectively (P=0.0221); the corresponding 5-year disease-specific survival (DSS) rates were 91.7%, 86.9%, and 85.1% (P=0.2136). Univariate analysis indicated that sex, smoking status, pathology, COPD severity, CCI, and pathological stage were associated with OS, and multivariate analysis confirmed the association with CCI and pathological stage. Postoperative complications were significantly more frequent in the GOLD 1 (21.5%) and GOLD 2/3 (26.8%) groups than in the non-COPD group (12.1%) (P=0.0040).Conclusions: Following thoracoscopic surgery (TS) for NSCLC, patients with COPD had a poorer OS than patients without COPD. However, the CCI and not the COPD severity was the independent prognostic factor for OS. Comorbidities adversely affected long-term survival of patients with stage I NSCLC and COPD after TS, and the same effect can be oncologically expected regardless of the COPD severity.Keywords: Non-small cell lung cancer (NSCLC); chronic obstructive pulmonary disease (COPD); Charlson comorbidity index (CCI); thoracoscopic surgery (TS)
OBJECTIVES Weight assessment is an easy-to-understand method of health checkup. The present study investigated the association between weight loss (WL) after lung cancer surgery and short–mid-term prognosis. METHODS The data of patients who underwent radical lobectomy for primary lung cancer were assessed between December 2017 and June 2021. Percentage weight gain or loss was determined at 3, 6 and 12 months postoperatively based on preoperative weight. The timing of decreased weight was divided into 0–3, 3–6 and 6–12 months. We also evaluated the relationship between severe WL (SWL) and prognosis. RESULTS We reviewed 269 patients, of whom 187 (69.5%) showed WL within 1 year after surgery. The interquartile range for maximal WL was 2.0–8.2% (median 4.0%). Further, we defined SWL as WL ≥ 8%. Twenty-five patients (9.3%) died: 9 from primary lung cancer (LC) and 16 from non-LC causes. Cancer recurrences occurred in 45 patients (16.7%). WL occurred from 6 to 12 months postoperatively was associated with poor overall survival (OS) and recurrence-free survival (RFS) (p < 0.05, both). Body mass index <18.5 kg/m2 and idiopathic pulmonary fibrosis were predictive factors (p < 0.05, all). In the SWL group, OS, RFS and non-cancer-specific were worse (p = 0.001, 0.005 and 0.019, respectively). Age ≥70 years and severe postoperative complications were predictive factors for SWL (p < 0.05, all). CONCLUSIONS WL from 6 to 12 months postoperatively and SWL were associated with poor prognosis. Ongoing nutritional management is important to prevent life-threatening WL in patients with predictive factors.
OBJECTIVES Postoperative pulmonary function is difficult to predict accurately, because it changes from the time of the operation and is also affected by various factors. The objective of this study was to assess the accuracy of predicted postoperative forced expiratory volume in 1 s (FEV1) at different postoperative times after lobectomy. METHODS This retrospective study enrolled 104 patients who underwent lobectomy by video-assisted thoracic surgery. Pulmonary function tests were performed preoperatively and postoperatively at 3, 6 and 12 months. We investigated time-dependent changes in FEV1. In addition, the ratio of measured to predicted postoperative FEV1 calculated by the subsegmental method was evaluated to identify the factors associated with variations in postoperative FEV1. RESULTS Compared with the predicted postoperative FEV1, the measured postoperative FEV1 was 8% higher at 3 months, 11% higher at 6 months and 13% higher at 12 months. The measured postoperative FEV1 significantly increased from 3 to 6 months (P = 0.002) and from 6 to 12 months (P = 0.015) after lobectomy resected lobe, smoking history and body mass index were significant factors associated with the ratio of measured to predicted postoperative FEV1 at 12 months (P < 0.001, P = 0.036 and P = 0.025, respectively). CONCLUSIONS Postoperative FEV1 increased up to 12 months after lobectomy by video-assisted thoracic surgery. The predicted postoperative pulmonary function was underestimated after 3 months, particularly after lower lobectomy.
BackgroundTissue harvesting for patients with a lung nodule is sometimes unsuitable due to the size and location of the nodule. In such cases, it is unclear whether it is acceptable to proceed to definitive lobectomy without intraoperative frozen section analysis.MethodsWe retrospectively reviewed patients who underwent definitive lobectomy or wedge resection for frozen section analysis at our institution between 2014 and 2018. The sensitivity, specificity, and accuracies of the clinical and frozen section diagnoses were evaluated against the final pathological diagnosis.ResultsThere were 141 patients in the definitive lobectomy group and 58 patients in the frozen section analysis group, with the latter having smaller and less deep nodules and a lower rate of malignancy on clinical and final pathological diagnoses. The sensitivity, specificity, and accuracy of the clinical diagnosis were 100%, 82%, and 95%, respectively, in the frozen section analysis group and 99%, 67%, and 97%, respectively, in the definitive lobectomy group; values of frozen section diagnosis were 98%, 82%, and 93%, respectively. On subgroup analysis, all ground‐glass nodules clinically diagnosed as malignant had a final pathological diagnosis of malignancy.ConclusionsThe accuracy of the clinical diagnosis was high and was not inferior to the frozen section diagnosis. These data suggest that definitive lobectomy is an acceptable treatment option for carefully selected patients with large or deep nodules and ground‐glass nodules clinically diagnosed as malignant. To avoid unnecessary lobectomy, frozen section diagnosis should be considered for nodules likely to be benign.Key pointsSignificant findings of the studyThe accuracy of the clinical diagnosis was high and was not inferior to the frozen section diagnosis.What this study addsDefinitive lobectomy is an acceptable treatment option for carefully selected patients with large or deep nodules and ground‐glass nodules with a clinical diagnosis of malignancy.
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