Clinical and quality of life outcomes following anatomical lung resection for lung cancer in high-risk patients

Abstract

BACKGROUND:Surgery remains the gold standard for patients with resectable nonsmall cell lung cancer. Current guidance identifies patients with poor pulmonary reserve to fall within a high-risk cohort. The aim of this study was to determine the clinical and quality of life outcomes of anatomical lung resection in patients deemed high risk based on pulmonary function measurements.METHODS:A retrospective review of patients undergoing anatomical lung resection for nonsmall cell lung cancer between January 2013 and January 2015 was performed. All patients with limited pulmonary reserve defined as predicted postoperative forced expiratory volume in 1 s or transfer factor of the lung for carbon monoxide of <40% were included in the study. Postoperative complications, admission to the Intensive Care Unit, length of stay, and 30-day in-hospital mortality were recorded. The European Organization for Research and Treatment of Cancer quality of life questionnaire lung cancer 13 questionnaire was used to assess quality of life outcomes.RESULTS:Fifty-three patients met the inclusion criteria. There was no in-hospital mortality, and 30-day mortality was 1.8%. No complications were seen in 64% (n = 34), minor complications occurred in 26% (n = 14), while 9% had a major complication (n = 5). Quality of life outcomes were above the reference results for patients with early stage lung cancer.CONCLUSION:Anatomical lung resection can be performed safely in selected high-risk patients based on pulmonary function without significant increase in morbidity or mortality and with acceptable quality of life outcomes. Given that complications following lung resection are multifactorial, fitness for surgery should be thoroughly assessed in all patients with resectable disease within a multidisciplinary setting. High operative risk by pulmonary function tests alone should not preclude surgical resection.

Chronic Obstructive Pulmonary Disease and Lung Cancer: A Review for Clinicians

“…In some patients, the operative risk of death exceeds the risk of lung cancer death. 167 The frequent occurrence of lung cancer in older COPD patients with other pulmonary and comorbid conditions has prompted exploration of therapies other than curative resection. 168 Lobectomy via video-assisted thoracoscopic surgery in high-risk patients (e.g., age>75years, FEV1<50% predicted, DLCO<50% predicted, history of coronary heart disease) has a low, but not negligible incidence of major complications.…”

Postoperative Management of Hyperinflated Native Lung in Single-Lung Transplant Recipients with Chronic Obstructive Pulmonary Disease: A Review Article

“…It is crucial to understand that post-transplant LVRS is a high-risk operation because of concerns regarding the frailty of patients receiving immunosuppressive drugs and the possibility of thoracic cavity adhesions and friable tissues, and the potential for prolonged air leaks [ 44 ]. Patient selection for LVRS is critical and should be preceded by a CT scan and perfusion scan [ 45 ]. Many published studies encourage the use of LVRS by demonstrating its feasibility and efficacy in improving forced expiratory volume in 1 s (FEV1), although the mean time from transplant to LVRS was approximately 50 months, which may exclude LVRS as an immediate postoperative strategy to treat ANLH ( 46 , 47 ).…”