Surgical risk evaluation of lung cancer in COPD patients – A cohort observational study

Abstract

Coexistence between pulmonary cancer and chronic obstructive pulmonary disease (COPD) is frequent and is anticipated to be lead to high worldwide mortality in the next decades. The most powerful therapeutic approach for non-small cell lung carcinoma is lung surgical resection. However, in COPD patients, this approach bears a higher mortality and morbidity risk, thus requiring an accurate pre-operatory evaluation of the surgical risk comprising a clinical and functional assessment at rest, as well as a cardiopulmonary exercise test. In this observational study, factors associated with cardiopulmonary complications within 30 days after tumor resection surgery were investigated in a cohort of patients with COPD and lung cancer assigned to perform a cardiopulmonary exercise test. This study included 50 patients (46 men, 92.0%) with a mean age of 64.7 years old (standard deviation 7.9), forced expiratory volume in the first second (FEV1) of 61.8% (SD 19.0%) and carbon monoxide diffusing capacity (DLCO) of 46.0% (SD 14.8%). Complications were observed in eighteen patients (36.0%) including 2 deaths (4.0%). Peak oxygen uptake (VO2peak) expressed in percentage of the predicted value was the only parameter showing a statistically significant difference between the groups with and without complications (p=0.027). The best value of VO2peak to discriminate complications occurrence was 61.0%. This study highlights the relevance of the cardiopulmonary exercise test in the risk assessment of pulmonary resection surgery in patients with COPD. The VO2peak (percentage of predicted value) is shown to be associated with complications within 30 days after surgery.

Associations between pretreatment physical performance tests and treatment complications in patients with non-small cell lung cancer: A systematic review

“…In all included studies, surgical resection for NSCLC was performed. Neoadjuvant chemotherapy and/or adjuvant chemotherapy were included in five studies (13 %) (Rodrigues et al, 2016;Brunelli et al, 2009b;Villani and Busia, 2004;Villani et al, 2003;Toker et al, 2007). An association between outcome variables of pretreatment exercise tests and postoperative cardiac and pulmonary complications and/or postoperative mortality was found in 33 of the 38 studies (87 %).…”

“…In 20 (80 %) of the 25 studies where the CPET was used preoperatively, one or more outcomes were statistically significant associated with postoperative complications. Cycle ergometry was used in 20 studies (80 %) (Smith et al, 1984;Miyazaki et al, 2018;Brutsche et al, 2000;Fang et al, 2013;Nagamatsu et al, 2004;Richter Larsen et al, 1997;Campione et al, 2010;Pate et al, 1996;Shafiek et al, 2016;Rodrigues et al, 2016;Vargas Fajardo Mdel et al, 2014;Licker et al, 2011;Varela et al, 2009;Brunelli et al, 2009b;Villani and Busia, 2004;Villani et al, 2003;Bechard and Wetstein, 1987;Bolliger et al, 1995;Epstein et al, 1993;Holden et al, 1992), of which 16 (80 %) reported that preoperative CPET variables were associated with postoperative complications. Different CPET protocols were used, with ten different workload increment protocols.…”

“…Fifteen studies (Smith et al, 1984;Miyazaki et al, 2018;Brutsche et al, 2000;Nagamatsu et al, 2004;Richter Larsen et al, 1997;Pate et al, 1996;Shafiek et al, 2016;Rodrigues et al, 2016;Licker et al, 2011;Brunelli et al, 2009b;Villani and Busia, 2004;Villani et al, 2003;Bechard and Wetstein, 1987;Epstein et al, 1993) reported that VO 2peak (both absolute values and values normalized for body mass) was associated with cardiac and pulmonary complications or mortality after surgery, whereas two studies merely reported an association with postoperative pulmonary complications (Fang et al, 2013;Villani et al, 2003). Predicted VO 2peak was associated with postoperative cardiac and pulmonary complications (Smith et al, 1984;Brutsche et al, 2000;Fang et al, 2013;Rodrigues et al, 2016;Licker et al, 2011;Villani and Busia, 2004;Villani et al, 2003), pulmonary complications (Brunelli et al, 2009b), and postoperative mortality (Richter Larsen et al, 1997;Brunelli et al, 2009b). Oxygen pulse at peak exercise was found to be associated with postoperative cardiac and pulmonary complications (Fang et al, 2013;Campione et al, 2010;Epstein et al, 1993), as well as with postoperative mortality (Fang et al, 2013).…”

Lung cancer and chronic obstructive pulmonary disease: From a clinical perspective

“…Multivariate analysis revealed that lower BMI, reduced DLCO%, and operation time were significant predictors of PPCs in COPD patients receiving cancer resection. In cardiopulmonary exercise testing, Rodrigues and colleagues found that the cutoff value of 61% for peak oxygen uptake was a significant discriminator between COPD patients with and without complications following tumor resection [ 82 ]. With regard to surgical approach, Jeon and colleagues performed a propensity score-matched analysis and demonstrated that video-assisted thoracoscopic surgery in lung cancer patients with comorbid COPD could reduce PPCs compared with thoracotomy [ 83 ].…”

Persistence of the Postoperative Change in the Six-minute Walking Distance of Lung Cancer Patients with Chronic Obstructive Pulmonary Disease

“… 20 ) Furthermore, COPD is a risk factor for pulmonary complications after pulmonary resection, 5 ) and COPD significantly increases the postoperative length of hospital stay compared to that of lung cancer patients without COPD. 21 ) The postoperative hospital stay for lung cancer patients is reported to be 4.3 days with preoperative rehabilitation and 9.7–12.2 days without preoperative rehabilitation. 8 ) In the present study, the mean postoperative hospital stay was 14.5±7.0 days, suggesting that prolonged hospitalization could make it difficult to maintain activity levels after surgery.…”