Ventilation defect burden predicts lung cancer resection outcomes

Abstract

BackgroundAbnormal ventilation prior to lung cancer resection has not been investigated using modern ventilation imaging modalities and may better predict postoperative outcomes than guideline-recommended lung function tests. Our objective was to quantify the burden of ventilation defects observed using Technegas-SPECT and129Xe-MRI before lung cancer resection, and to evaluate their association with postoperative pulmonary complications and length of hospital stay.MethodsThis was a prospective, six-week, observational study of adults undergoing lung cancer resection at a single-centre. Before lung resection, participants underwent Technegas-SPECT,129Xe-MRI, spirometry, and diffusing capacity of the lung for carbon monoxide. Preoperative ventilation defect burden was quantified by the Technegas-SPECT and129Xe-MRI ventilation-defect-percent (VDP). Predictors of complications during the four-week postoperative period and length of hospital stay were evaluated by logistic and linear regression.ResultsAbnormal ventilation was observed preoperatively by Technegas-SPECT and129Xe-MRI for 58% (60 of 103) and 73% (74 of 102) of participants, respectively. Preoperative VDPs were higher for participants with postoperative complications compared to those without (SPECT:p=0.01; MRI:p=0.0006) and correlated with length of hospital stay (SPECT:r=0.44,p<0.0001; MRI:r=0.51,p<0.0001). Multivariable models revealed preoperative VDP to be the strongest predictor of postoperative complications (SPECT: OR=1.06, 95% CI: 1.01 to 1.11,p=0.02; MRI: OR=1.11, 95% CI=1.02 to 1.21,p=0.02) and length of hospital stay (SPECT:β=0.16,p<0.001; MRI:β=0.23,p<0.001).ConclusionAbnormal ventilation is prevalent prior to lung cancer resection and may be a stronger predictor of postoperative complications and length of hospital stay than standard clinical lung function measures.

Role of quantitative ventilation/perfusion scan (qVQ) in the pre-treatment assessment of bronchoscopic lung volume reduction with endobronchial valves (BLVR-EBV) for emphysema and the pre-operative assessment for lung cancer: a systematic review

“…Radadia et al ( 14 ) quantified the total amount of ventilation defects (Hermes ® ) defined as a percentage of total thoracic cavity volume [ventilation defect percent (VDP)] using ventilation SPECT in 107 participants who proceeded to lung resection for malignancy. They found VDP to independently predict PO complications [odds ratio (OR) =1.06, 95% confidence interval (CI): 1.01–1.11; P=0.02], there was doubling of risk for every 12% increase in VDP.…”

Role of quantitative ventilation/perfusion scan (qVQ) in the pre-treatment assessment of bronchoscopic lung volume reduction with endobronchial valves (BLVR-EBV) for emphysema and the pre-operative assessment for lung cancer: a systematic review

“…Radadia et al ( 14 ) quantified the total amount of ventilation defects (Hermes ® ) defined as a percentage of total thoracic cavity volume [ventilation defect percent (VDP)] using ventilation SPECT in 107 participants who proceeded to lung resection for malignancy. They found VDP to independently predict PO complications [odds ratio (OR) =1.06, 95% confidence interval (CI): 1.01–1.11; P=0.02], there was doubling of risk for every 12% increase in VDP.…”

Role of quantitative ventilation/perfusion scan (qVQ) in the pre-treatment assessment of bronchoscopic lung volume reduction with endobronchial valves (BLVR-EBV) for emphysema and the pre-operative assessment for lung cancer: a systematic review

“…Radadia et al ( 14 ) quantified the total amount of ventilation defects (Hermes ® ) defined as a percentage of total thoracic cavity volume [ventilation defect percent (VDP)] using ventilation SPECT in 107 participants who proceeded to lung resection for malignancy. They found VDP to independently predict PO complications [odds ratio (OR) =1.06, 95% confidence interval (CI): 1.01–1.11; P=0.02], there was doubling of risk for every 12% increase in VDP.…”

Role of quantitative ventilation/perfusion scan (qVQ) in the pre-treatment assessment of bronchoscopic lung volume reduction with endobronchial valves (BLVR-EBV) for emphysema and the pre-operative assessment for lung cancer: a systematic review

“…Radadia et al ( 14 ) quantified the total amount of ventilation defects (Hermes ® ) defined as a percentage of total thoracic cavity volume [ventilation defect percent (VDP)] using ventilation SPECT in 107 participants who proceeded to lung resection for malignancy. They found VDP to independently predict PO complications [odds ratio (OR) =1.06, 95% confidence interval (CI): 1.01–1.11; P=0.02], there was doubling of risk for every 12% increase in VDP.…”