Predictors of respiratory failure after thoracic surgery: a retrospective cohort study with comparison between lobar and sub-lobar resection

Abstract

Objective Only approximately 15% of patients with lung cancer are suitable for surgery and clinical postoperative outcomes vary. The aim of this study was to investigate variables associated with post-surgery respiratory failure in this patient cohort. Methods Patients who underwent surgery for lung cancer were retrospectively studied for respiratory function. All patients had undergone lung resection by a mini-thoracotomy approach. The study population was divided into two subgroups for comparison: lobectomy group, who underwent lobar resection; and sub-lobar resection group. Results A total of 85 patients were included, with a prevalence of lung cancer stage IA and adenocarcinoma histotype. Lobectomy (versus sub-lobar resection), the presence of chronic obstructive pulmonary disease (COPD), and a COPD assessment test (CAT) score >10, were all associated with an increased risk of respiratory failure. The partial pressure of arterial oxygen decreased more in the lobectomy group than in the sub-lobar resection group following surgery, with a significant postoperative between-group difference in values. Postoperative CAT scores were also better in the sub-lobar resection group. Conclusions Post-surgical variations in functional parameters were greater in the group treated by lobectomy. COPD, high CAT score and surgery type were associated with postoperative development of respiratory failure.

Association of Respiratory Functional Indices and Smoking with Pleural Movement and Mean Lung Density Assessed Using Four-Dimensional Dynamic-Ventilation Computed Tomography in Smokers and Patients with COPD

“…In addition, the presence of emphysema and conventional static lung hyperinflation parameters, such as the percentage of low attenuation area less than −950 HU, was also demonstrated to be associated with an increased risk of postoperative respiratory failure in cases with lung cancer. 24 This study also demonstrated that pleural movement in the dependent aspect was larger than in the non-dependent aspect, even in smokers without airflow limitation compared with non-smokers (Figures 6 and 7) (Videos S2 and S3). Furthermore, MPMV ND/D decreased as MLD at maximum as inspiration increased; in other words, the extent/degree of lung parenchymal collapse at peak inspiration became larger in smokers, especially for the dependent lung field.…”

“…In addition, the presence of emphysema and conventional static lung hyperinflation parameters, such as the percentage of low attenuation area less than −950 HU, was also demonstrated to be associated with an increased risk of postoperative respiratory failure in cases with lung cancer. 24

Figure 5 Example images on the median sagittal plane for the left upper lung field for three intermittent time frames in a COPD patient. Median sagittal images for the upper lung field at three intermittent time frames in an 83-year-old male patient with COPD demonstrate smaller movements in the non-dependent pleural aspect compared with the dependent pleural aspect.

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A rare case of hepatoid adenocarcinoma of the lung

“…Early implementation of anatomic pneumonectomy is crucial for enhancing the survival rate of patients. Therefore, surgeons should actively participate in the assessment and functional evaluation of the patient's clinical stage and resectability, as well as determine surgical indications and techniques based on tumour progression and the patient's functional status 12 . For patients with late‐stage HAL or unresectable tumour, chemoradiotherapy can be combined with other adjuvant therapy 13 .…”

Naples Prognostic Score as an Independent Predictor of Survival Outcomes for Resected Locally Advanced Non-Small Cell Lung Cancer Patients After Neoadjuvant Treatment

“… 40 , 41 The patients with respiratory failure post-surgery were excluded to ensure follow-up antitumor therapy. 42 The thoracic surgeons encouraged patients to perform the early rehabilitation exercises and nutritional support. Sequentially, patients received adjuvant chemotherapy or chemoradiotherapy after surgery.…”