Prediction of Surgical Outcome by Modeling Based on Risk Factors of Morbidity After Pulmonary Resection for Lung Cancer in Older Adults

Abstract

Our model displayed an acceptable ability to predict surgical outcome in older patients undergoing pulmonary resection for lung cancer. Use of the model can be helpful in decision making about surgical treatment in this special population.

Perioperative Factors for Predicting the Need for Postoperative Intensive Care after Major Lung Resection

“…Based on previous studies, morbidity within 1 year after surgery was defined as the occurrence of the following adverse events: arrhythmia, atrial fibrillation, air leak for longer than 5 days, pneumothorax, bleeding requiring reoperation, pneumonia, myocardial infarct, bronchopleural fistula, acute respiratory distress syndrome (ARDS), ventricular arrhythmia, ventilatory support, pulmonary edema, heart failure, renal failure requiring hemodialysis, and cerebrovascular accident or transient ischemic attack [11,12,13]. In addition, Charlson comorbidity scores, postoperative hospital stay, and mortality were used in the outcome analysis.…”

Association between averaged intraoperative nociceptive response index and postoperative complications after lung resection surgery

“…Intraoperative variables for use in anaesthetic management, including mean NR index during surgery ≥0.831, duration of surgery ≥221 min, blood loss ≥0.08 ml kg −1 h −1 and urine volume <2.17 ml kg −1 h −1 , showed significant associations with postoperative complications of Clavien–Dindo grade ≥II in the present study. Although reported intraoperative risk factors for postoperative complications after lung cancer surgery include higher levels of surgical invasion as seen with thoracotomy compared to VATS or robot-assisted thoracic surgery, large tumour size, tumour location, longer duration of surgery and higher blood loss [ 16 , 21 , 22 ], to our knowledge, this study is the first to show intraoperative variables for use in anaesthetic management as risk factors for Clavien–Dindo grade ≥II in patients with primary lung cancer.…”

“…The incidence of postoperative complications was significantly higher in patients with mean NR index ≥0.831 than in patients with mean NR index <0.831 in the present study. Higher mean NR index represents a higher degree of surgical invasiveness [ 23 ], which is reportedly one of the risk factors for postoperative complications after lung cancer surgery [ 16 , 20 , 21 ]. Since a higher level of surgical invasion causes greater surgical stress responses in terms of sympathetic activity, stress hormone release and inflammation and eventually induces postoperative complications [ 24–26 ], the significant correlation of higher mean NR index with postoperative complications makes sense in the present study.…”

“…Preoperative variables of male sex and BMI <25 kg m −2 were selected as independent risk factors for postoperative complications in the present study. Previous studies have also reported male sex and low nutritional and immunological status, in addition to older age, higher ASA-PS grade, concomitant asthma or pulmonary disease, low percentage of forced expiratory volume in 1 s and current smoking, as preoperative risk factors for postoperative complications after lung cancer surgery [ 14–16 , 20 , 21 , 30 , 31 ]. In previous studies investigating the relationship between sex and postoperative complications after lung cancer surgery, male patients exhibited higher postoperative morbidity and mortality.…”

Commentary: Too old or not too old, that is the question: Video-assisted thoracoscopic surgery is (part of) the answer

“…In this context, the expected results of the STEPS study (NCT 02360761), which is the first randomized central trial comparing sublobar resection versus lobectomy on the surgical treatment of elderly patients with early-stage nonsmall cell lung cancer, might be of great management importance. Last but not least, this article also had the important merit of emphasizing some fundamental points: the rigorous selection of patients as the result of predictive risk modeling 9 and the mandatory implementation of a fasttracking program.…”