Cluster analysis of emphysema for predicting pulmonary complications after thoracoscopic lobectomy

Abstract

OBJECTIVES Despite significant advances in surgical techniques, including thoracoscopic approaches and perioperative care, the morbidity rate remains high after lung resection. This study focused on a low attenuation cluster analysis, which represented the size distribution of pulmonary emphysema and assessed its utility for predicting postoperative pulmonary complications after thoracoscopic lobectomy. METHODS From April 2013 to September 2018, lung cancer patients who received spirometry and computed tomography (CT) before surgery and underwent thoracoscopic lobectomy were included. The cumulative size distribution of the low attenuation area (LAA, defined as ≤−950 Hounsfield unit on CT) clusters followed a power-law characterized by an exponent D-value, a measure of the complexity of the alveolar structure. D-value and LAA% (LAA/total lung volume) were calculated using preoperative 3-dimensional CT software. The relationship between pulmonary complications and patient characteristics, including D-value and LAA%, was investigated. RESULTS Among 471 patients, there were 61 respiratory complication cases (12.9%). Receiver operation characteristic curve analysis revealed that the best predictive cut-off value of D-value and LAA% for pulmonary complications was 2.27 and 16.5, respectively, with an area under the curve of 0.72 and 0.58, respectively. D-value was significantly correlated with % forced expiratory volume in 1 s. Per univariate analysis, gender, smoking history, forced expiratory volume in 1 s/forced vital capacity, LAA% and D-value were risk factors for predicting postoperative pulmonary complications. In the multivariate analysis, D-value remained a significant predictive factor. CONCLUSION Preoperative assessment of emphysema cluster analysis may represent the vulnerability of the operated lung and could be the novel predictor for pulmonary complications after thoracoscopic lobectomy.

Analysis for discharge within 2 days after thoracoscopic anatomic lung cancer surgery

“…The occurrence of male sex discharged after postoperative Day 2 was higher with no clear biological explanation. And this relationship may not be directly causal, but a possible explanation was the higher incidence of postoperative poor outcomes 21,22 . In addition, extensive lung resection was a marker of complexity or difficulty and might increase operative time and perioperative adverse complications, 23,24 where methods to reduce postoperative air leakage, such as fissure‐less dissection, in turn, were also likely beneficial in reducing length of hospital stay 25 …”

“…And this relationship may not be directly causal, but a possible explanation was the higher incidence of postoperative poor outcomes. 21,22 In addition, extensive lung resection was a marker of complexity or difficulty and might increase operative time and perioperative adverse complications, 23,24 where methods to reduce postoperative air leakage, such as fissure-less dissection, in turn, were also likely beneficial in reducing length of hospital stay. It is well known that thoracoscopic anatomic lung resection combined with systematic lymph node removal is regarded as the optimal treatment for lung cancer.…”

The dynamic pulmonary functional change after thoracoscopic lower lobe segmentectomy

“…9,10 It can also be applied to other analyses, including calculations of lung volume, as well as quantitative and morphological assessment of emphysema as demonstrated previously. 11 Using this cutting-edge 3D A, C). There were no significant differences in predicted and actual residual lobe volume (S6; p = 0.191, complex; p = 0.115) (B, D).…”

“…9,10 It can also be applied to other analyses, including calculations of lung volume, as well as quantitative and morphological assessment of emphysema as demonstrated previously. 11 Using this cutting-edge 3D reconstruction software, we investigated the postoperative functional difference between thoracoscopic segmentectomy and lobectomy in the lower lobe and examined whether segmentectomy type could affect the dynamic change in the residual lobe.…”

The difference in postoperative pulmonary functional change between upper and lower thoracoscopic lobectomy

“…There has been increasing evidence on the association between D -value and the progression of chronic obstructive pulmonary disease [ 8 , 9 ]. D -value likely predicts pulmonary complications after thoracoscopic lobectomy [ 10 ]. In addition to the quantitative assessment of pulmonary emphysema, the D -value has been utilized to evaluate the structural quality of the lungs [ 11 ].…”