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

Abstract

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.

Comparison of postoperative complications between segmentectomy and lobectomy by video-assisted thoracic surgery: a multicenter study

“…One explanation for the higher rate of complications in our study is that we included all types of complications. We report postoperative complications routinely and extensively, which could increase the number of complications [17, 18]. In addition, the higher rate of patient comorbidities in our study, as compared to some other studies, could increase the rate of complication, as established in the European risk models for morbidity (Eurolung1) score [19].…”

Risk factors for post‐operative pulmonary complications in lung cancer patients after video‐assisted thoracoscopic lung resection: Results of the German Thorax Registry

“…(McMillan 2014) Not only short-term but also long-term survival after lung resection surgery is significantly influenced by the occurrence of PPCs. 5 Several risk factors for PPCs after lung surgery have been identified. These are increased age, gender, pre-operative forced expiratory volume in 1 second (FEV 1 ) ≤ 60%, duration of surgery, body mass index (BMI) ≥ 30 kg/m 2 , smoking, ASA score ≥3, chronic obstructive lung disease (COPD) and increased intraoperative fluid administration.…”

Short-Physical Performance Battery (SPPB) score is associated with postoperative pulmonary complications in elderly patients undergoing lung resection surgery: A prospective multicenter cohort study

“…These results are consistent with those found in this study. 2,3 Ellenberger et al 29 showed that a direct relationship between poor pre-operative physical performance and postoperative pulmonary complications. It has been shown that patients with lung cancer, who are at risk of poor physical function preoperatively may benefit from physiotherapy to improve physical function before surgery to prevent postoperative pulmonary complications, shorten hospital length of stay and lower in-hospital cost.…”