Assessment of Operative Risk in Patients Undergoing Lung Resection

Kearney, David J.; Lee, T. H.; Reilly, John J.; DeCamp, Malcolm M.; Sugarbaker, David J.

doi:10.1097/00132586-199412000-00038

Cited by 40 publications

(57 citation statements)

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“…Während Stephan et al eine positive Sputumbakteriologie für die Diagnose einer nosokomialen Pneumonie fordern [23], geben Kearney et al in ihrer Publikation überhaupt keine Pneumoniedefinition an [8]. Wang nieren jedes neue radiologische Infiltrat, das von Fieber begleitet ist und die intravenöse Verabreichung von Antibiotika erforderlich macht, als Pneumonie [30].…”

Section: Diskussionunclassified

Bronchoplastische Resektionen in der Behandlung maligner Lungentumoren

Hollaus

Wurnig

Pridun

2002

Chirurg

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Section: Diskussionunclassified

Bronchoplastische Resektionen in der Behandlung maligner Lungentumoren

Hollaus

Wurnig

Pridun

2002

Chirurg

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“…Wenige Arbeiten haben die prognostische Relevanz der Pulsoximetrie vor geplanter Lungenresektion untersucht [26,34,39,46]. In einer Studie von 331 Patienten wurde keine Korrelation zwischen der arteriellen Sauerstoffsättigung (SaO 2 ) K 90 % unter Belastung und postoperativen Komplikationen gefunden [26].…”

Section: Pulmonaler Gasaustauschunclassified

“…In einer Studie von 331 Patienten wurde keine Korrelation zwischen der arteriellen Sauerstoffsättigung (SaO 2 ) K 90 % unter Belastung und postoperativen Komplikationen gefunden [26]. Markos dagegen zeigte, daû bei Patienten mit Lobektomie postoperative Komplikationen umso häufiger auftraten, je ausgeprägter der Abfall von SaO 2 unter maximaler Belastung war [34].…”

Section: Pulmonaler Gasaustauschunclassified

“…Widersprüchliche Aussagen liegen hinsichtlich der Bewertung einer Hyperkapnie (PaCO 2 > 45 mm Hg) vor [1,5,7,26,50]. Hyperkapnie kann Ausdruck einer verminderten pulmonalen Reserve sein und damit ein erhöhtes Operationsrisiko widerspiegeln, andererseits aber auch Ausdruck einer Depression des Atemzentrums, einer neuromuskulären Erkrankung oder eines anatomischen Rechts-Links-Shunts sein.…”

Section: Pulmonaler Gasaustauschunclassified

“…Alternativ wurde vorgeschlagen, die Anzahl der mutmaûlich zu resezierenden Segmente (S) zu zählen und unter der Annahme, daû jedes der 19 Lungensegmente gleichmäûig zur Lungenfunktion beiträgt, das postoperativ zu erwartende FEV 1 entsprechend der Formel FEV 1 -ppo = FEV 1 präoperativ [(19-S) /19] zu berechnen [26]. Diese Formel macht den Einsatz der Szintigraphie überflüssig, hat aber den Nachteil, daû die Funktion der resezierten Segmente nicht berücksichtigt wird, was zu einer Überschätzung des Funktionsverlustes und Ablehnung der Operation führen kann [64].…”

Section: Belastungsuntersuchungenunclassified

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Risikoabschätzung von Patienten vor Lungenresektion

Schulz

Emslander

Riedel

1999

Chirurg

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Lung resection offers the best prospect of long-term survival in patients with nonmetastatic pulmonary neoplasia. In view of the dismal prognosis of unresected bronchial cancer, surgical resection should be encouraged even in patients with reduced cardiopulmonary function. Accurate estimation of the postoperative cardiopulmonary function is therefore desirable to avoid (a) refusal of potentially curative treatment and (b) severe postoperative disability. The origins of post-resection morbidity and mortality are multifactorial. Thus, no single pulmonary function test or hemodynamic measurement can accurately and reliably predict postoperative cardiorespiratory complications. Criteria of functional operability should be based on percent of predicted value, so that patient's age, sex, and height will be taken into consideration. Exercise testing offers the advantage that both pulmonary and cardiac risk can be evaluated simultaneously. The high predictive value of maximal oxygen uptake (VO2max) in assessing postoperative morbidity and mortality is established. The calculation of predicted postoperative lung function (ppo) is of importance. The postoperative values for the forced expiratory volume in one second (FEV1-ppo), the transfer factor (TL,CO-ppo), and VO2max-ppo can be predicted by using the same formula. Patients with nearly normal lung function (FEV1, TL,CO > 75% predicted) and no concomitant cardiac disease can undergo lung resection right up to pneumonectomy without further diagnostic procedures. In the others, FEV1-ppo and TL,CO-ppo should be estimated first by taking into account the number of segments to be resected. Patients with values < 30% predicted are usually regarded as being inoperable, whereas values > 40% predicted qualify for resection without the need for further diagnostics. VO2max < 10 ml/kg/min or < 40% predicted are prohibitive for surgery. If VO2max is > 20 ml/kg/min or > 75% predicted, functional operability without limitation is given. For those cases where diagnostic uncertainty still remains, FEV1-ppo, TL,CO-ppo, and VO2max-ppo can be calculated by means of quantitative lung scans. Patients with either FEV1-ppo and TL,CO-ppo < 30% predicted or VO2max-ppo < 8 ml/kg/min or < 35% predicted are deemed inoperable.

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Comparison of relative forced expiratory volume of one second with dynamic magnetic resonance imaging parameters in healthy subjects and patients with lung cancer

Plathow

Fink

Sandner

et al. 2005

Magnetic Resonance Imaging

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Purpose: To assess relative forced expiratory volume in one second (FEV1/vital capacity (VC)) in healthy subjects and patients with a lung tumor using dynamic magnetic resonance imaging (dMRI) parameters. Materials and Methods:In 15 healthy volunteers and 31 patients with a non-small-cell lung carcinoma stage I (NSCLC I), diaphragmatic length change (LE1) and craniocaudal (CC) intrathoracic distance change within one second from maximal inspiration (DE1) were divided by total length change (LE total , DE total ) as a surrogate of spirometric FEV1/VC using a true fast imaging with steady-state precession (trueFISP) sequence (TE/TR ϭ 1.7/37.3 msec, temporal resolution ϭ 3 images/second). Influence of tumor localization was examined. Results:In healthy volunteers FEV1/VC showed a highly significant correlation with LE1/LE total and DE1/DE total (r Ͼ 0.9, P Ͻ 0.01). In stage IB tumor patients, comparing tumor-bearing with the non-tumor-bearing hemithorax, there was a significant difference in tumors of the middle (LE1/LE total ϭ 0.63 Ϯ 0.05 vs. 0.73 Ϯ 0.04, DE1/DE total ϭ 0.66 Ϯ 0.05 vs. 0.72 Ϯ 0.04; P Ͻ 0.05) and lower (P Ͻ 0.05) lung region. Stage IA tumor patients showed no significant differences with regard to healthy subjects.Conclusion: dMRI is a simple noninvasive method to locally determine LE1/LE total and DE1/DE total as a surrogate of FEV1/VC in volunteers and patients. Tumors of the middle and lower lung regions have a significant influence on these MRI parameters.

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Assessment of Operative Risk in Patients Undergoing Lung Resection

Cited by 40 publications

References 0 publications

Bronchoplastische Resektionen in der Behandlung maligner Lungentumoren

Bronchoplastische Resektionen in der Behandlung maligner Lungentumoren

Risikoabschätzung von Patienten vor Lungenresektion

Comparison of relative forced expiratory volume of one second with dynamic magnetic resonance imaging parameters in healthy subjects and patients with lung cancer

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