Early and Long-term Validation of an Algorithm Assessing Fitness for Surgery in Patients With Postoperative FEV 1 and Diffusing Capacity of the Lung for Carbon Monoxide &lt; 40%

Puente-Maestu, Luís; Villar, F.; González-Casurrán, Guillermo; Moreno, Nicolás; Martínez, Yolanda; Simón, Carlos; Peñalver, Rafael; González-Aragoneses, Federico

doi:10.1378/chest.10-1069

Cited by 23 publications

(16 citation statements)

References 35 publications

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“…Several studies have demonstrated acceptable postoperative outcome in patients with a PPO lung function as low as 30% predicted. Puente-Maestú et al 138 compared acute morbidity and mortality, as well as 2-year survival, in subjects with a PPO FEV 1 and PPO D lco . 30% predicted.…”

Section: Cardiopulmonary Exercise Testingmentioning

confidence: 99%

Physiologic Evaluation of the Patient With Lung Cancer Being Considered for Resectional Surgery

Brunelli

Kim

Berger

et al. 2013

Chest

752

448

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Section: Cardiopulmonary Exercise Testingmentioning

confidence: 99%

Physiologic Evaluation of the Patient With Lung Cancer Being Considered for Resectional Surgery

Brunelli

Kim

Berger

et al. 2013

Chest

752

448

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“…In addition, using the historical 40 % cut-off to select patients suitable for surgery with an acceptable clinical outcome, decision-making would have been different in 2 additional patients. Nevertheless, there were no patients with PPO FEV1 or PPO DLCO lower than 30 %, which has been recently described as a more adapted cut-off [6, 19]. …”

Section: Discussionmentioning

confidence: 99%

Gallium-68 perfusion positron emission tomography/computed tomography to assess pulmonary function in lung cancer patients undergoing surgery

et al. 2016

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BackgroundPre-operative evaluation of lung cancer patients relies on calculation of predicted post-operative (PPO) lung function based on split lung function testing. Pulmonary perfusion (Q) PET/CT can now be performed by substituting Technetium-99 m labeling of macroaggregated albumin (MAA) with Gallium-68. This study compares Q PET/CT with current recommended methods of pre-operative lung function assessment.MethodsTwenty-two patients planned for curative surgical resection (mean FEV1 77 %, SD 21 %; mean DLCO 66 %, SD 17 % predicted) underwent pre-operative Q PET/CT. Sixteen patients also underwent conventional lung scintigraphy. Lobar and lung split PPO lung function were calculated using Q PET/CT and current recommended methods, i.e. calculation based on anatomical segments for lobar function, and conventional perfusion scan for pneumonectomy. Bland-Altman statistics were used to calculate agreement between methods for PPO FEV1 and PPO DLCO.ResultsWhile mean split lobar functions were comparable, there was variation on an individual level between Q PET/CT and the anatomical method, with absolute difference over 5 % and 10 % in 37 % and 11 % of patients, respectively. For lobectomy the mean difference in PPO FEV1 was−1.2, but limits of agreement were−10 to 8.1 %. For DLCO, values were−1.1 % and−9.7 to 7.5 %, respectively. For pneumonectomy, PPO FEV1 values were−0.4 and−5.9 to 5.1 %. For DLCO, values were 0.3 % and−5.1 to 4.6 %.ConclusionsWhile anatomic estimation provides “fixed” results, split lobar functions computed with Q PET/CT vary widely, reflecting the intra and inter-individual variability of regional lung function. Further studies to assess the role of Q PET/CT in predicting peri-operative risk in lung cancer patients planned for lobectomy are warranted.

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“…Some authors recently have extended this range to less than 40%, considering values as low as 30% as presenting an intermediate risk; 3,4,[17][18][19] although the patient populations evaluated in such studies with very low levels of lung function were heterogeneous and the results were not compared with patient outcomes. 17,18 Nevertheless, this cut-off has been introduced into clinical practice on the basis of indirect evidence and expert consensus opinion.…”

Section: The Pulmunologist's Perspectivementioning

confidence: 99%

“…17,18 Nevertheless, this cut-off has been introduced into clinical practice on the basis of indirect evidence and expert consensus opinion. 4 In a recent report on video-assisted thoracoscopic surgical (VATS) lobectomy, a preoperative FEV 1 or DLCO o30% of predicted values was shown to be a contraindication for surgery, and no other tests for the risk stratification of lung function were recommended at this point.…”

Section: The Pulmunologist's Perspectivementioning

confidence: 99%

Preoperative Evaluation of Patients Undergoing Lung Resection Surgery: Defining the Role of the Anesthesiologist on a Multidisciplinary Team

Rocca

Vetrugno

Coccia

et al. 2016

Journal of Cardiothoracic and Vascular Anesthesia

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Early and Long-term Validation of an Algorithm Assessing Fitness for Surgery in Patients With Postoperative FEV 1 and Diffusing Capacity of the Lung for Carbon Monoxide < 40%

Cited by 23 publications

References 35 publications

Physiologic Evaluation of the Patient With Lung Cancer Being Considered for Resectional Surgery

Physiologic Evaluation of the Patient With Lung Cancer Being Considered for Resectional Surgery

Gallium-68 perfusion positron emission tomography/computed tomography to assess pulmonary function in lung cancer patients undergoing surgery

Preoperative Evaluation of Patients Undergoing Lung Resection Surgery: Defining the Role of the Anesthesiologist on a Multidisciplinary Team

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