Prediction of pulmonary complications after a lobectomy in patients with non-small cell lung cancer

Abstract

Background-Although the preoperative prediction of pulmonary complications after lung major surgery has been reported in various papers, it still remains unclear. Methods-Eighty nine patients with stage I-IIIA non-small cell lung cancer (NSCLC) who underwent a complete resection at our institute from 1994-8 were evaluated for the feasibility of making a preoperative prediction of pulmonary complications. All had either a predicted postoperative forced vital capacity (FVC) of >800 ml/m 2 or forced expiratory volume in one second (FEV 1 ) of >600 ml/m 2 . Results-Postoperative complications occurred in 37 patients (41.2%) but no patients died during the 30 day period after the operation. Pulmonary complications occurred in 20 patients (22.5%). Univariate analysis indicated that the factors significantly related to pulmonary complications were FVC <80%, serum lactate dehydrogenase (LDH) level >230 U/l, and arterial oxygen tension (PaO 2 ) <10.6 kPa (80 mm Hg). In a multivariate analysis the three independent predictors of pulmonary complications were serum LDH >230 U/l (odds ratio (OR) 10.5, 95% CI 1.4 to 77.3), residual volume (RV)/total lung capacity (TLC) >30% (OR 6.0, 95% CI 1.1 to 33.7), and PaO 2 <10.6 kPa (OR 5.6, 95% CI 1.4 to 22.2). Conclusions-The above findings indicate that three factors (serum LDH levels of >230 U/l, RV/TLC >30%, and PaO 2 <10.6 kPa) may be associated with pulmonary complications in patients undergoing a lobectomy for NSCLC, even though the patient group was relatively small for statistical analysis of such a diverse subject as pulmonary complications. (Thorax 2001;56:59-61) Keywords: non-small cell lung cancer; pulmonary complications; morbidity Lung cancer is the leading cause of death among cancer patients. 1 The necessity for surgical treatment is increasing because complete surgical removal of a tumour oVers the best chance for a cure in patients with non-small cell lung cancer (NSCLC). 2 3 A lobectomy remains the standard therapeutic option in most patients with early stage NSCLC. Although the operative mortality and morbidity following a lobectomy has decreased over the past decade, both factors still contribute significantly to the cost of treating such patients. Careful selection of the operative modalities is therefore required to reduce the overall mortality and morbidity.Clinicians are often faced with the problem of morbidity, especially pulmonary complications, which tend to be impossible to predict. Pulmonary complications after lung resection can have serious consequences because the remaining lung tissue is severely compromised during the immediate postoperative period. In the present study we have reviewed a series of patients with NSCLC to evaluate the feasibility of preoperatively predicting pulmonary complications. Methods PATIENTSFrom April 1994 to December 1998, 299 patients with primary lung cancer underwent lung resection at the Department of Surgery II, University of Occupational and Environmental Health, Kitakyushu, Japan. Of these, 89 patients wit...

Video-assisted thoracic surgery involving major pulmonary resection for central tumors

“…The VATS group in this study achieved a rate for lymphadenectomy-related morbidity, including chylothorax and recurrent nerve injury, equivalent to that for other studies of VATS [21,22]. The morbidity rate for this study is acceptable due to the absence of serious complications and a lower morbidity rate than found in other studies using open thoracotomy [14,23,24].…”

Predictors of atelectasis after pulmonary lobectomy

“…1,2 The overall incidence of postoperative pulmonary complications after pulmonary resection is approximately 30%, but ranges from 7% to 49%. [3][4][5][6] The most common complications are prolonged air leak (1%-15%), bacterial pneumonia (4.8%-15%), acute respiratory failure (2.4%-10%), and postoperative atelectasis (1%-20%). 3,4,[7][8][9] The wide variation in the incidence of postoperative atelectasis is attributed to the lack of consensus about a defi nition of clinical atelectasis.…”

Risk factors for short-term outcomes after thoracoscopic lobectomy for lung cancer

“…Consecutive patients with preoperative stage I NSCLC who underwent thoracoscopic lobectomy were eligible for the current study. The indications for major pulmonary resection via thoracoscopic lobectomy were based on the standard criteria for an open thoracotomy, including a tumour of ⩽6 cm in diameter [13], and a predicted postoperative (PPO) forced vital capacity of >800 mL·m −2 or a forced expiratory volume in 1 s (FEV1) of >600 mL·m −2 [14]. Patients were excluded if they had an Eastern Cooperative Oncology Group performance status [15] of 3-4, underwent pneumonectomy or were unable to walk independently at the time of admission.…”