Prediction of Functional Reserves after Lung Resection: Comparison between Quantitative Computed Tomography, Scintigraphy, and Anatomy

Bolliger, Chris T.; Gückel, C; Engel, Hermann; Stöhr, Susanne; Wyser, C; Schoetzau, Andreas; Habicht, James; Solèr, Markus; Tamm, Michael; Perruchoud, André P.

doi:10.1159/000066474

Cited by 115 publications

(117 citation statements)

References 16 publications

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“…The following equation was used to estimate the predicted post-lobectomy FEV1 using perfusion scan results [16]: predicted ppo FEV15pre-operative FEV1(1-functional contribution of perfusion of the region to be resected). In order to estimate the predicted post-pneumonectomy FEV1, the equation was as follows: FEV15pre-operative FEV1(1-percentage perfusion of lung to be resected).…”

Section: Predicted Post-operative Fev1mentioning

confidence: 99%

Relationship between pulmonary function and lung cancer surgical outcome

Win

Jackson²,

Sharples³

et al. 2005

Eur Respir J

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The British Thoracic Society and American College of Chest Physician guidelines outline criteria for investigating patients for lung cancer surgery. However, the guidelines are based on relatively old studies. Therefore, the relationship between pulmonary function test results and surgical outcome were studied prospectively in a large cohort of lung cancer patients.From January 2001 to December 2003, 110 patients underwent surgery for lung cancer. All underwent full lung function testing in order to predict post-operative lung function.The hospital mortality rate was 3% and major complication rate 22%. There was poor overall outcome in 13%. Mean pre-operative lung function values were: forced expiratory volume in one second (FEV1) 2.0 L (79.4% of the predicted value), and carbon monoxide diffusing capacity of the lung (DL,CO) 73.6% pred. The mean post-operative lung function values were: FEV1 1.4 L (55.6% pred), and DL,CO 51.3% pred. All lung function values were better predictors of poor surgical outcome when expressed as a percentage of the predicted value. Using a threshold of preoperative FEV1 of 47% pred resulted in the most useful positive and negative predictive probabilities, 0.90 and 0.67, respectively.Lung function values expressed as a percentage of the predicted value are more useful predictors of post-operative outcome than absolute values. The threshold of predicted forced expiratory volume in one second for surgical intervention could be lower (45-50% pred) than is currently accepted without increased mortality.KEYWORDS: Lung carcinoma, lung function, lung function tests, surgical resection S urgical resection remains the treatment of choice for anatomically resectable nonsmall cell lung cancer [1,2], offering the best prospect of long-term survival. However, many patients have coexisting chronic airflow limitation [3], which is associated with an increased risk from surgery. Loss of lung tissue may grossly impair post-operative ventilatory function in such patients, predisposing to cardiopulmonary complications, including death. The British Thoracic Society (BTS) and American College of Chest Physician guidelines [4,5] outline criteria for investigating patients with borderline lung function. However, many of the studies on which the guidelines are based are relatively old, and often based on predominantly male patients who were significantly younger than patients currently being considered for surgery.The latest BTS guidelines suggest that further investigation is unnecessary if a patient has a forced expiratory volume in one second (FEV1) of .2.0 L for pneumonectomy or .1.5 L for lobectomy. This is because studies have shown a mortality rate of ,5% using these criteria. However, these figures are based mainly on studies involving males, and it is likely that lower values would be more appropriate for females. It is possible that a figure based on a value expressed as a percentage of the predicted value would be better still, since this would also take into account the patient's age, s...

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Section: Predicted Post-operative Fev1mentioning

confidence: 99%

Relationship between pulmonary function and lung cancer surgical outcome

Win

Jackson²,

Sharples³

et al. 2005

Eur Respir J

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“…Studies with quantitative radionuclide lung scanning 19,20 are useful in preoperative evaluation. Pierce et al 6 found that a new index, designated the predicted postoperative product, obtained by multiplying the percent-of-predicted postoperative FEV 1 by the percent-of-predicted postoperative D LCO , has the strongest ability for predicting mortality.…”

Section: Discussionmentioning

confidence: 99%

Predicted Postoperative Product and Diffusion Heterogeneity Index in the Evaluation of Candidates for Lung Resection

Wang¹,

Abboud

Graham

2011

Respir Care

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“…Predicted post-operative ( ppo ) values were obtained according to ERS/ESTS clinical guidelines [5,13] using preoperative pulmonary function data with information on the number of bronchopulmonary segments removed (for lobectomy) or fraction of total perfusion for the lung to be resected (for pneumonectomy) using preoperative radiologic studies).…”

Section: Predicted Post-operative Valuesmentioning

confidence: 99%

Minute ventilation to carbon dioxide output (V’E/V’CO2 slope) is the strongest death predictor before larger lung resections

Torchio¹,

Mazzucco²,

Guglielmo³

et al. 2017

Monaldi Arch Chest Dis

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The minute ventilation to carbon dioxide (CO 2 ) production ratio (V' E /V' CO2 slope) was recently identified as a mortality predictor after lung surgery, but the effect of the resection extent was not taken into account. The aim of this study was to investigate the role of V' E /V' CO2 slope as preoperative mortality predictor depending on the type of surgery performed. Retrospective analysis was performed on 263 consecutive patients evaluated before surgery for lung cancer. Death within 30 days and serious respiratory complications were considered. Univariate and multivariate regression analyses were used to identify independent predictors of death. Lobectomy or bilobectomy were performed in 186 patients with 29/186 (15.6%) serious pulmonary complications and 6/186 (3.2%) deaths. Pneumonectomy was performed in 77 patients with 14/77 (18.2%) serious complications and 5/77 (6.5%) deaths. Considering the whole group, the peak oxygen consumption (V' O2peak, L/min; z=-2.66, p<0.008, OR 0.007) and V' E /V' CO2 slope (z=2.80, p<0.005, OR 1.14) were independent predictors of mortality whereas in pneumonectomies V' E /V' CO2 slope (z=2.34, p<0.02, OR 1.22) was the only independent predictor of mortality. High V' E /V' CO2 slope, age and low V' O2peak are predictors of death and severe complications after lung surgery. Before larger resections as pneumonectomies an increased V' E /V' CO2 slope represents the best mortality predictor.

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Prediction of Functional Reserves after Lung Resection: Comparison between Quantitative Computed Tomography, Scintigraphy, and Anatomy

Cited by 115 publications

References 16 publications

Relationship between pulmonary function and lung cancer surgical outcome

Relationship between pulmonary function and lung cancer surgical outcome

Predicted Postoperative Product and Diffusion Heterogeneity Index in the Evaluation of Candidates for Lung Resection

Minute ventilation to carbon dioxide output (V’E/V’CO2 slope) is the strongest death predictor before larger lung resections

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