Prediction of Postoperative Respiratory Failure in Patients Undergoing Lung Resection for Lung Cancer

Nakahara, Kazunari; Ohno, Kiyoshi; Hashimoto, Junpei; Miyoshi, Shinichiro; Maeda, Hitoshi; Matsumura, Akira; Mizuta, T; Akashi, Akira; Nakagawa, Kazuyuki; Kawashima, Yasunaru

doi:10.1016/s0003-4975(10)64694-2

Cited by 120 publications

(54 citation statements)

References 19 publications

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“…The latter has been associated with mortality rates ranging from 16% to 50% [263][264][265][266]. Mortality rates as high 60% have been reported when the predicted postoperative FEV1 is <30% [267,268]. However, because many patients qualified as at high risk after calculation of predicted postoperative lung function can undergo surgery safely, decisions are made on an individual basis [269].…”

Section: End-of-life Carementioning

confidence: 99%

An official American Thoracic Society/European Respiratory Society statement: research questions in COPD

et al. 2015

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Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity, mortality, and resource use worldwide. The goal of this official American Thoracic Society (ATS)/European Respiratory Society (ERS) research statement is to describe evidence related to diagnosis, assessment and management; identify gaps in knowledge; and make recommendations for future research. It is not intended to provide clinical practice recommendations on COPD diagnosis and management.Clinicians, researchers, and patient advocates with expertise in COPD were invited to participate. A literature search of Medline was performed, and studies deemed relevant were selected. The search was not a systematic review of the evidence. Existing evidence was appraised and summarised, and then salient knowledge gaps were identified.Recommendations for research that addresses important gaps in the evidence in all areas of COPD were formulated via discussion and consensus.Great strides have been made in the diagnosis, assessment and management of COPD, as well as understanding its pathogenesis. Despite this, many important questions remain unanswered. This ATS/ ERS research statement highlights the types of research that leading clinicians, researchers, and patient advocates believe will have the greatest impact on patient-centred outcomes. @ERSpublications ATS/ERS statement: which types of research will have the greatest future impact on patientcentred outcomes in COPD? http://ow.ly/I54Hb

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Section: End-of-life Carementioning

confidence: 99%

An official American Thoracic Society/European Respiratory Society statement: research questions in COPD

et al. 2015

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“…This is followed by an exercise test, either a shuttle walking test or a formal cardiopulmonary exercise test. Many previous studies have shown predictive values for specific cut-off levels of FEV1 and DL,CO [6][7][8][9][10][11]. A study performed by PIERCE et al [12] suggested that the product of ppo FEV1 and ppo DL,CO (both % pred) was the most useful predictor of survival from surgery.…”

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confidence: 98%

Relationship between pulmonary function and lung cancer surgical outcome

Win

Jackson²,

Sharples³

et al. 2005

European Respiratory Journal

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The British Thoracic Society and American College of Chest Physician guidelines outline criteria for investigating patients for lung cancer surgery. However, the guidelines are based on relatively old studies. Therefore, the relationship between pulmonary function test results and surgical outcome were studied prospectively in a large cohort of lung cancer patients.From January 2001 to December 2003, 110 patients underwent surgery for lung cancer. All underwent full lung function testing in order to predict post-operative lung function.The hospital mortality rate was 3% and major complication rate 22%. There was poor overall outcome in 13%. Mean pre-operative lung function values were: forced expiratory volume in one second (FEV1) 2.0 L (79.4% of the predicted value), and carbon monoxide diffusing capacity of the lung (DL,CO) 73.6% pred. The mean post-operative lung function values were: FEV1 1.4 L (55.6% pred), and DL,CO 51.3% pred. All lung function values were better predictors of poor surgical outcome when expressed as a percentage of the predicted value. Using a threshold of preoperative FEV1 of 47% pred resulted in the most useful positive and negative predictive probabilities, 0.90 and 0.67, respectively.Lung function values expressed as a percentage of the predicted value are more useful predictors of post-operative outcome than absolute values. The threshold of predicted forced expiratory volume in one second for surgical intervention could be lower (45-50% pred) than is currently accepted without increased mortality.KEYWORDS: Lung carcinoma, lung function, lung function tests, surgical resection S urgical resection remains the treatment of choice for anatomically resectable nonsmall cell lung cancer [1,2], offering the best prospect of long-term survival. However, many patients have coexisting chronic airflow limitation [3], which is associated with an increased risk from surgery. Loss of lung tissue may grossly impair post-operative ventilatory function in such patients, predisposing to cardiopulmonary complications, including death. The British Thoracic Society (BTS) and American College of Chest Physician guidelines [4,5] outline criteria for investigating patients with borderline lung function. However, many of the studies on which the guidelines are based are relatively old, and often based on predominantly male patients who were significantly younger than patients currently being considered for surgery.The latest BTS guidelines suggest that further investigation is unnecessary if a patient has a forced expiratory volume in one second (FEV1) of .2.0 L for pneumonectomy or .1.5 L for lobectomy. This is because studies have shown a mortality rate of ,5% using these criteria. However, these figures are based mainly on studies involving males, and it is likely that lower values would be more appropriate for females. It is possible that a figure based on a value expressed as a percentage of the predicted value would be better still, since this would also take into account the patient's age, s...

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“…These authors were the first to use percentage of predicted values instead of absolute values. Subsequently, others have confirmed that perioperative risk increase substantially when the ppoFEV 1 is <40% of predicted normal (17)(18)(19)(20)(21)(22)(23).…”

Section: Pulmonary Function Evaluationmentioning

confidence: 96%

Preoperative functional workup for patients with advanced lung cancer

Brunelli

2016

J. Thorac. Dis.

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Locally advanced lung cancer remains a surgical indication in selected patients. This condition often demands larger resections. As a consequence preoperative functional workup is of paramount importance to stratify the risk and choose the most appropriate treatment. We reviewed the current evidence on functional evaluation with a special focus on specific aspects related to locally advanced lung cancer stages (i.e., risk after neoadjuvant treatment, pneumonectomy). Evidence is discussed to provide information that could assist clinicians in their preoperative workup of these challenging patients.

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Prediction of Postoperative Respiratory Failure in Patients Undergoing Lung Resection for Lung Cancer

Cited by 120 publications

References 19 publications

An official American Thoracic Society/European Respiratory Society statement: research questions in COPD

An official American Thoracic Society/European Respiratory Society statement: research questions in COPD

Relationship between pulmonary function and lung cancer surgical outcome

Preoperative functional workup for patients with advanced lung cancer

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