Postoperative Severe Lung Failure and Functional Variations in Lung Cancer Patients with Different Extent of Resection: A Pilot Study .

Abstract

BACKGROUND Lung cancer is recognized to be the main cause of cancer death worldwide and it is closely associated with cigarette smoking and chronic obstructive pulmonary disease (COPD). Only about 15% of patients affected by lung cancer are suitable for surgery and the clinical postoperative outcomes are variable.We aim to investigate the variables that affect post-surgery complications .METHODS A sample of 75 patients who underwent surgery for lung cancer was retrospectively studied about respiratory function and arterial gasanalysis .Data were collected before and after surgery. A subgroups comparative analysis was performed between group who underwent lobectomy vs group who underwent sub-lobar resection represented by either wedge or segmentectomy. Lung failure was categorized as severe for PaO2< 50 mmHg or non severe for PaO2 >50 mmHg.RESULTSThe overall data were: mean age 71.5, hospitalization time 7.8 days, pack-year 34, body mass index (BMI) 25.4, chronic obstructive pulmonary disease(COPD) assessment test (CAT) mean value was 16.5, forced expiratory one second volume (FEV1) at baseline 1.6 l corresponding to 73.6% of predicted.The mean age was 71.5, males/females rate 35/30The prevalent stage was IA and prevalent histotype was adenocarcinoma.Among the variables affecting lung failure development only the type of surgery along with presence of COPD showed a significant impact.Comparing the groups about the risk of severe lung failure development the treatment with lobectomy is associated with an increased risk compared with sub-lobar resection (p<0.0005). A CAT questionnaire > 10 was also associated with greater risk of lung failure with oxygen therapy need(p<0.04).The subgroups were comparable for age and pack-year , and for PaO2, FEV 1 and FVC at baseline. A significant difference was observed in terms of hospitalization time (p<0.03) that was longer in group of lobectomy and PaO2 15 days after surgery (p<0.03). The COPD percentage was higher in the group treated by lobectomy (p<0.01). The PaO2 level increased at 3 month check in patients treated with sub-lobar resection that was slightly increased compared with patients treated with lobar resection (p<0.04)post-surgery (p<0.04). The variations of the main functional parameters FEV1 and FVC in terms of a reduction the main functional parameters FEV1 and FVC were more evident in patients who underwent lobectomy compared with group treated with sub-lobar resection(p<0.001).CONCLUSIONSAll patients affected by lung cancer who undergo surgery report lung failure of different intensity depending on the type of surgery.COPD itself could influence the outcome, too. A greater negative variations of functional parameters after surgery is found in group who undergo lobectomy.