Preoperative functional workup for patients with advanced lung cancer

Brunelli, Alessandro

doi:10.21037/jtd.2016.03.73

Cited by 13 publications

(8 citation statements)

References 84 publications

(86 reference statements)

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“…Nowadays, there is growing scientific evidence of the utility of V E /VCO 2 in assessing athletic performances and in providing diagnostic and prognostic information in patients with cardiovascular, pulmonary and neuromuscular diseases as well as in those with deconditioning related to immobilization, sedentarity and aging (11). The V E /VCO 2 ratio is independent of peak VO 2 as a prognostic marker, and a subgroup of patients with a high V E /VCO 2 and a low peak VO 2 have been identified to experience the worst outcome (27). Likewise, in a small cohort of 55 COPD patients undergoing lung cancer resection, Shafiek et al reported that V E /VCO 2 slope >35 was a predictor of oneyear survival (10).…”

Section: Discussionmentioning

confidence: 99%

Patient and procedural features predicting early and mid-term outcome after radical surgery for non-small cell lung cancer

Ellenberger¹,

Garofano²,

Reynaud³

et al. 2018

J. Thorac. Dis

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Background: Postoperative cardiovascular and pulmonary complications (PCVCs and PPCs) are frequent and result in prolonged hospital stay. The aim of this study was to update the risk factors associated with major complications and survival after lung cancer surgery. Methods: This is a post-hoc analysis of a randomized controlled trial that was designed to assess the benefits of preoperative physical training. After enrollment, clinical, biological and functional data as well as intraoperative details were collected. In-hospital PCVCs and PPCs were recorded and survival data were adjudicated up to 4 years after surgery. Results: Data from 151 patients were analyzed. Thirty-day mortality rate was 2.6% and the incidence of PCVCs and PPCs was 15% and 33%, respectively. Stepwise logistic regression analysis showed that, PCVCs were mainly related to elevated plasma levels of brain natriuretic peptides [odds ratios (ORs) =6.0; 95% confidence interval (CI), 1.3-27.3] and performance of a pneumonectomy (OR =9.6; 95% CI, 2.9-31.5) whereas PPCs were associated with the presence of COPD (OR =5.9; 95% CI, 2.4-14.8), current smoking (OR =2.6; 95% CI, 1.1-6.5) and the need for blood transfusion (OR =5.2; 95% CI, 1.2-23.3). Preoperative physical training was a protective factor regarding PPCs (OR =0.13; 95% CI, 0.05-0.34). Cox proportional hazards regression analysis showed that ventilatory inefficiency during exercise (expressed by a ratio >40 of ventilation to carbon dioxide elimination), coronary artery disease, elevated plasma levels of brain natriuretic peptides and the occurrence of PPCs were all predictive of poor survival after surgery. Conclusions: Besides smoking and the extent of lung resection, preexisting cardiopulmonary disease as evidence by elevated levels of brain natriuretic peptides and inefficient ventilation are associated with poor clinical outcome after lung cancer surgery.

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Section: Discussionmentioning

confidence: 99%

Patient and procedural features predicting early and mid-term outcome after radical surgery for non-small cell lung cancer

Ellenberger¹,

Garofano²,

Reynaud³

et al. 2018

J. Thorac. Dis

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“…A preoperative cardio-respiratory physiological assessment was performed in all patients. This consisted in a transthoracic echocardiography and a spirometry, completed by an ergo-spirometry and a pulmonary scintigraphy if the forced expiratory volume in one second (FEV 1 ) and/or the diffusing capacity of the lung for carbon monoxide (DLCO) were lower than 80% of the predicted value (10). Three attending specialized surgeons performed or supervised the different operations during the entire study period and a fourth specialized surgeon joined the team since 2018.…”

Section: Operationmentioning

confidence: 99%

Is faster better? Impact of operative time on postoperative outcomes after VATS anatomical pulmonary resection

Forster¹,

Hasenauer²,

Perentes³

et al. 2022

J Thorac Dis

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Background: Video-assisted thoracic surgery (VATS) is now the preferred approach for standard anatomical pulmonary resections. This study evaluates the impact of operative time (OT) on post-operative outcomes after VATS anatomical pulmonary resection for non-small cell lung cancer (NSCLC). Methods:We retrospectively reviewed all consecutive patients undergoing VATS lobectomy or segmentectomy for NSCLC between November 2010 and December 2019. Postoperative outcomes were compared between short (<150 minutes) and long (≥150 minutes) OT groups. A multivariable analysis was performed to identify predictors of long OT and overall post-operative complications.Results: A total of 670 patients underwent lobectomy (n=496, 74%) or segmentectomy (n=174, 26%) for NSCLC. Mediastinal lymph node dissection was performed in 621 patients (92.7%). The median OT was 141 minutes (SD: 47 minutes) and 387 patients (57.8%) were operated within 150 minutes. Neoadjuvant chemotherapy was given in 25 patients (3.7%). Conversion thoracotomy was realized in 40 patients (6%).Shorter OT was significantly associated with decreased post-operative overall complication rate (30% vs. 41%; P=0.003), shorter median length of drainage (3 vs. 4 days; P<0.001) and shorter median length of hospital stay (6 vs. 7 days; P<0.001). On multivariable analysis, long OT (≥150 minutes) (OR 1.64, P=0.006), ASA score >2 (OR 1.87, P=0.001), FEV 1 <80% (OR 1.47, P=0.046) and DLCO <80% (OR 1.5, P=0.045) were significantly associated with postoperative complications. Two predictors of long OT were identified: neoadjuvant chemotherapy (OR 3.11, P=0.01) and lobectomy (OR 1.5, P=0.032).Conclusions: A prolonged OT is significantly associated with postoperative complications in our collective of patients undergoing VATS anatomical pulmonary resection.

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“…Brunelli reported that induction chemotherapeutic agents were associated with a 10% to 20% reduction in DLCO. 24 Furthermore, this decrease in DLCO after induction therapy has been associated with perioperative respiratory complications. 25 However, limited research has been performed to identify functional markers that predict perioperative morbidity and mortality among patients who undergo surgical resection after induction therapy.…”

Section: Discussionmentioning

confidence: 99%

Postinduction therapy pulmonary function retesting is necessary before surgical resection for non–small cell lung cancer

Connolly

Fiasconaro

Tan

et al. 2022

The Journal of Thoracic and Cardiovascular Surgery

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Preoperative functional workup for patients with advanced lung cancer

Cited by 13 publications

References 84 publications

Patient and procedural features predicting early and mid-term outcome after radical surgery for non-small cell lung cancer

Patient and procedural features predicting early and mid-term outcome after radical surgery for non-small cell lung cancer

Is faster better? Impact of operative time on postoperative outcomes after VATS anatomical pulmonary resection

Postinduction therapy pulmonary function retesting is necessary before surgical resection for non–small cell lung cancer

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