Influence of chronic obstructive pulmonary disease on postoperative lung function and complications in patients undergoing operations for primary non–small cell lung cancer

Subotic, Dragan; Mandaric, D.; Eminovic, Tatjana; Gajić, Milan; Mujović, Nataša; Atanasijadis, Nikola; Dzeletovic, P.; Andric, Ljiljana; Bulajic, Branka M.; Dimitrijevic, Ivan D.; Sobic, D.

doi:10.1016/j.jtcvs.2007.07.038

Cited by 36 publications

(23 citation statements)

References 22 publications

(23 reference statements)

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“…to maintain adequate flow at low lung volumes. This is in line with our previous report on 35 COPD patients in whom 18% and 25.6% improvement in FEF50 was registered after lobectomy, compared with slight decrease of these values in the control group [25]. The tendency of smaller FEV1 loss in patients with moderate and severe COPD, compared with patients with better preserved lung function, as registered in our study, additionally supports similar results published in recent years, demonstrating that such a finding does not always exist only due to lung volume reduction effect [26,27].…”

Section: Discussionsupporting

confidence: 93%

Influence of Pulmonary Rehabilitation on Lung Function Changes After the Lung Resection for Primary Lung Cancer in Patients with Chronic Obstructive Pulmonary Disease

Mujović

Subotic

et al. 2015

Aging and disease

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Influence of physiotherapy on the outcome of the lung resection is still controversial. Study aim was to assess the influence of physiotherapy program on postoperative lung function and effort tolerance in lung cancer patients with chronic obstructive pulmonary disease (COPD) that are undergoing lobectomy or pneumonectomy. The prospective study included 56 COPD patients who underwent lung resection for primary non small-cell lung cancer after previous physiotherapy (Group A) and 47 COPD patients (Group B) without physiotherapy before lung cancer surgery. In Group A, lung function and effort tolerance on admission were compared with the same parameters after preoperative physiotherapy. Both groups were compared in relation to lung function, effort tolerance and symptoms change after resection. In patients with tumors requiring a lobectomy, after preoperative physiotherapy, a highly significant increase in FEV1, VC, FEF50 and FEF25 of 20%, 17%, 18% and 16% respectively was registered with respect to baseline values. After physiotherapy, a significant improvement in 6-minute walking distance was achieved. After lung resection, the significant loss of FEV1 and VC occurred, together with significant worsening of the small airways function, effort tolerance and symptomatic status. After the surgery, a clear tendency existed towards smaller FEV1 loss in patients with moderate to severe, when compared to patients with mild baseline lung function impairment. A better FEV1 improvement was associated with more significant loss in FEV1. Physiotherapy represents an important part of preoperative and postoperative treatment in COPD patients undergoing a lung resection for primary lung cancer.Key words: pulmonary rehabilitation, preoperative physiotherapy, lung cancer, lobectomy, pneumonectomy During the previous decade, functional assessment of patients that were diagnosed with lung cancer that are undergoing surgery significantly changed. Cut-off values of ventilatory parameters that are used in treatment planning particularly forthe safe resection have been changed, along with improvement of postoperative lung function prediction and operative risk assessment methods [1][2][3]. In addition, as it was convincingly demonstrated that age itself is not a contraindication for surgery, there is increasing evidence of safe surgical treatment in septuagenarians and even in octogenarians [4,5].

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Section: Discussionsupporting

confidence: 93%

Influence of Pulmonary Rehabilitation on Lung Function Changes After the Lung Resection for Primary Lung Cancer in Patients with Chronic Obstructive Pulmonary Disease

Mujović

Subotic

et al. 2015

Aging and disease

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“…Many studies have shown minimal loss or even improvement of pulmonary function after lobectomy by the so-called "lung volume reduction effect" in patients with airflow limitations, thus making estimations of postoperative pulmonary function difficult. 24) Quality of life after lobectomy in patients with COPD is similar to patients without COPD, despite an increased risk of postoperative cardiopulmonary complications, 25) and there were no in-hospital deaths in the current study.…”

Section: Discussionmentioning

confidence: 53%

Worse Prognosis for Stage IA Lung Cancer Patients with Smoking History and More Severe Chronic Obstructive Pulmonary Disease

Yoshida

Kage

Murakawa

et al. 2015

ATCS

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IntroductionLung cancer is the most commonly diagnosed cancer and the leading cause of cancer death in males worldwide. 1) Tobacco smoking is the best established risk factor for lung cancer and the most common risk factor for chronic obstructive lung disease (COPD). 2) COPD is the fourth leading cause of death worldwide and occurs in 30% of patients with lung cancer. 2) Spirometry is used to assess the risk for perioperative death and cardiopulmonary complications after resection of the lung, with a predicted postoperative forced expiratory volume in one second (FEV 1 ) value of 30% indicating a high risk. 3,4) Purpose: This retrospective study examined whether the severity of chronic obstructive lung disease (COPD) affects surgical outcomes. Methods: The subjects were 243 consecutive patients who underwent lobectomy for clinical stage IA lung cancer from 1999 to 2008 in our hospital. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) grading system was used to classify the severity of COPD in smokers. Results: Among the 149 smokers, 62 were diagnosed with COPD (25 as GOLD 1, 33 as GOLD 2, and 4 as GOLD 3). In univariate analysis, postoperative pulmonary complications were associated with male sex and more severe COPD. The frequencies were 17.1% in non-COPD, 24.0% in GOLD 1-COPD, and 46.0% in GOLD 2/3-COPD smokers (p = 0.0006). In univariate analysis, older age, smoking history, higher smoking pack-years and more severe COPD were associated with poor relapse-free survival. Relapse-free survival at five years was 80.7%, 66.9%, and 61.3% in non-COPD, GOLD 1-COPD, and GOLD 2/3-COPD smokers, respectively (p = 0.0005). Multivariate analyses showed that only GOLD 2/3-COPD was associated with postoperative pulmonary complications and relapse-free survival. Inhaled bronchodilators were prescribed preoperatively to 24.3% of the GOLD 2/3-COPD group. Conclusion: Smokers with GOLD 2/3-COPD are at high risk for pulmonary complications and have an unfavorable long-term prognosis.

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“…Acceptable peri-operative mortality rate (0-6%) with prolonged cancer-free interval and sustained functional improvement (up to 1 yr) have been reported in selected patients with pre-operative FEV1 ,60% [49,212,219,223,225]. Although long-term survival after lobar LVRS for stage I lung cancer is limited by physiological rather than oncological factors, outcomes are still better than those reported for any other modality of treatment.…”

Section: Surgical Techniques In Lung Cancermentioning

confidence: 99%

ERS/ESTS clinical guidelines on fitness for radical therapy in lung cancer patients (surgery and chemo-radiotherapy)

Brunelli¹,

Charloux²,

Bolliger³

et al. 2009

European Respiratory Journal

750

550

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A collaboration of multidisciplinary experts on the functional evaluation of lung cancer patients has been facilitated by the European Respiratory Society (ERS) and the European Society of Thoracic Surgery (ESTS), in order to draw up recommendations and provide clinicians with clear, up-to-date guidelines on fitness for surgery and chemo-radiotherapy.The subject was divided into different topics, which were then assigned to at least two experts. The authors searched the literature according to their own strategies, with no central literature review being performed. The draft reports written by the experts on each topic were reviewed, discussed and voted on by the entire expert panel. The evidence supporting each recommendation was summarised, and graded as described by the Scottish Intercollegiate Guidelines Network Grading Review Group. Clinical practice guidelines were generated and finalised in a functional algorithm for risk stratification of the lung resection candidates, emphasising cardiological evaluation, forced expiratory volume in 1 s, systematic carbon monoxide lung diffusion capacity and exercise testing.Contrary to lung resection, for which the scientific evidences are more robust, we were unable to recommend any specific test, cut-off value, or algorithm before chemo-radiotherapy due to the lack of data. We recommend that lung cancer patients should be managed in specialised settings by multidisciplinary teams.

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Influence of chronic obstructive pulmonary disease on postoperative lung function and complications in patients undergoing operations for primary non–small cell lung cancer

Cited by 36 publications

References 22 publications

Influence of Pulmonary Rehabilitation on Lung Function Changes After the Lung Resection for Primary Lung Cancer in Patients with Chronic Obstructive Pulmonary Disease

Influence of Pulmonary Rehabilitation on Lung Function Changes After the Lung Resection for Primary Lung Cancer in Patients with Chronic Obstructive Pulmonary Disease

Worse Prognosis for Stage IA Lung Cancer Patients with Smoking History and More Severe Chronic Obstructive Pulmonary Disease

ERS/ESTS clinical guidelines on fitness for radical therapy in lung cancer patients (surgery and chemo-radiotherapy)

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