PREOPERATIVE PULMONARY FUNCTION AS A PREDICTOR OF RESPIRATORY COMPLICATIONS AND MORTALITY IN PATIENTS UNDERGOING LUNG CANCER RESECTION

Abstract

Objective: We evaluated preoperative pulmonary function as a predictor of respiratory complications and mortality in patients undergoing lung cancer resection to confirm the guideline of the British Thoracic Society : lung cancer surgery in patients with predictive postoperative FEV_1.0 (%FEV_1.0ppo)>40% and predictive postoperative diffusion capacity for carbon monoxide (%DL_COppo)>40% can be carried out with average risk.
Methods: We retrospectively studied 356 consecutive patients who underwent pulmonary resection at our Department from January 1992 to December 2001. Preoperative pulmonary function tests included vital capacity (VC), %VC, forced expiratory volume in one second (FEV_1.0), FEV_1.0%, diffusion capacity for carbon monoxide (DL_CO), predictive postoperative FEV_1.0 (FEV_1.0 ppo), postoperative respiratory function expressed as a percentage of the predicted normal value (%FEV_1.0ppo, %DL_COppo). Postoperative complications were divided into 2 groups: respiratory complications (pneumonia, atelectasis, etc) and other complications (bronchopleural fistu la, prolonged air leak, arrhythmia, etc).
Results: Postoperative deaths occurred in 14 (3.9%) patients. Postoperative respiratory complications developed in 27 (7.6%) patients. Pneumonectomy (p<0.001), preoperative chemotherapy (p<0.01) and advanced stage (p<0.05) were identified as risk factors of postoperative deaths.
Patients undergoing lobectomy with FEV_1.0≥1,500 ml did not die of respiratory complications. Patients undergoing pneumonectomy with FEV_1.0ppo≥800 ml/m² did not die of respiratory complications. Patients undergoing pneumonectomy with %FEV_1.0ppo<40% and %DL_COppo<40% did not survive. Five of the 7 patients who died of respiratory complications were treated with preoperative chemotherapy. The values of their %DL_COppo were all less than 40%. By multivariate analysis, %FEV_1.0ppo was significant independent factor associated postoperative death.
Conclusions: We conclude that the guideline is useful for the selection for surgery of lung cancer patients. If preoperative chemotherapy is performed, the measurement of %DL_CO is recommended before surgery.