Preoperative Pulmonary Function Tests (PFTs) and Outcomes from Resected Early Stage Non-small Cell Lung Cancer (NSCLC)

Almquist, Daniel; Khanal, Nabin; Smith, Lynette; Ganti, Apar Kishor

doi:10.21873/anticanres.12537

Cited by 10 publications

(4 citation statements)

References 13 publications

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“…DLCO reflects the capillary surface area available for gas diffusion. Preoperative DLCO has been demonstrated to predict the risk of complications, short- and long-term outcomes and the length of hospitalization in patients undergoing thoracic surgery [ 21 ]. The meta-analysis showed a lower degree of DLCO decrease in the segmentectomy group, indicating that it had better preservation of oxygenation.…”

Section: Discussionmentioning

confidence: 99%

The impact of segmentectomy versus lobectomy on pulmonary function in patients with non-small-cell lung cancer: a meta-analysis

Qin

et al. 2022

J Cardiothorac Surg

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Objective Segmentectomy has been reported as an alternative to lobectomy for small-sized NSCLC without detriment to survival. The long-term benefits of segmentectomy over lobectomy on pulmonary function have not been firmly established. This meta-analysis aims to compare postoperative changes in pulmonary function in NSCLC patients undergoing segmentectomy or lobectomy. Methods Medline, Embase, Web of Science and Scopus were searched through March 2021. Statistical comparisons were made when appropriate. Results Fourteen studies (2412 participants) out of 324 citations were included in this study. All selected studies were high quality, as indicated by the Newcastle–Ottawa scale for assessing the risk of bias. Clinical outcomes were compared between segmentectomy and lobectomy. ΔFEV1 [10 studies, P < 0.01, WMD = 0.40 (0.29, 0.51)], ΔFVC [4 studies, P < 0.01, WMD = 0.16 (0.07, 0.24)], ΔFVC% [4 studies, P < 0.01, WMD = 4.05 (2.32, 5.79)], ΔFEV1/FVC [2 studies, P < 0.01, WMD = 1.99 (0.90, 3.08)], and ΔDLCO [3 studies, P < 0.01, WMD = 1.30 (0.69, 1.90)] were significantly lower in the segmentectomy group than in the lobectomy group. Subgroup analysis showed that in stage IA patients, the ΔFEV1% [3 studies, P < 0.01, WMD = 0.26 (0.07, 0.46)] was significantly lower in the segmentectomy group. The ΔDLCO% and ΔMVV% were incomparable. Conclusion Segmentectomy preserves more lung function than lobectomy. There were significantly smaller decreases in FEV1, FVC, FVC%, FEV1/FVC and DLCO in the segmentectomy group than in the lobectomy group.

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Section: Discussionmentioning

confidence: 99%

The impact of segmentectomy versus lobectomy on pulmonary function in patients with non-small-cell lung cancer: a meta-analysis

Qin

et al. 2022

J Cardiothorac Surg

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“…It is recommended that all lung cancer patients who are candidates for surgery should have pulmonary function tests (PFTs), because the parameters of PFTs are very useful for lung cancer preoperative risk assessments [8,9]. More than that, in recent years, emerging studies suggested that valuable PFT parameters might also play a role in predicting prolonged p-LOS following lung resection: Some suggested inspiratory capacity (IC) and some suggested forced expiratory volume in 1 s (FEV 1 ) or diffusion capacity for carbon monoxide (DLCO) [10,11]. Currently, it is still worthy to unveil more optimal or novel predictors among these various PFTs for better prediction of prolonged p-LOS after lung cancer surgery.…”

Section: Electronic Supplementary Materialsmentioning

confidence: 99%

Development and validation of nomogram estimating post-surgery hospital stay of lung cancer patients: relevance for predictive, preventive, and personalized healthcare strategies

Wang

et al. 2019

EPMA Journal

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Objective In the era of fast track surgery, early and accurately estimating whether postoperative length of stay (p-LOS) will be prolonged after lung cancer surgery is very important, both for patient's discharge planning and hospital bed management. Pulmonary function tests (PFTs) are very valuable routine examinations which should not be underutilized before lung cancer surgery. Thus, this study aimed to establish an accurate but simple prediction tool, based on PFTs, for achieving a personalized prediction of prolonged p-LOS in patients following lung resection. Methods The medical information of 1257 patients undergoing lung cancer surgery were retrospectively reviewed and served as the training set. p-LOS exceeding the third quartile value was considered prolonged. Using logistic regression analyses, potential predictors of prolonged p-LOS were identified among various preoperative factors containing PFTs and intraoperative factors. A nomogram was constructed and subjected to internal and external validation. Results Five independent risk factors for prolonged p-LOS were identified, including older age, being male, and ratio of residual volume to total lung capacity (RV/TLC) ≥ 45.0% which is the only modifiable risk factor, more invasive surgical approach, and surgical type. The nomogram comprised of these five predictors exhibited sufficient predictive accuracy, with the area under the receiver operating characteristic curve (AUC) of 0.76 [95% confidence interval (CI) 0.73-0.79] in the internal validation. Also its predictive performance remained fine in the external validation, with the AUC of 0.70 (95% CI 0.60-0.79). The calibration curves showed satisfactory agreements between the model predicted probability and the actually observed probability. Conclusions Preoperative amelioration of RV/TLC may prevent lung cancer patients from unnecessary prolonged p-LOS. The integrated nomogram we developed could provide personalized risk prediction of prolonged p-LOS. This prediction tool may help patients perceive expected hospital stays and enable clinicians to achieve better bed management after lung cancer surgery.

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“…However, the predictive capabilities of these factors were poor. Moreover, poor pulmonary function, as determined by the PFT, was not associated with low morbidity or mortality in patients undergoing VATS for lung cancer surgery (11,12). Berry et al (13) concluded that preoperative PFT was associated with PPCs after lung cancer surgery only in thoracotomy, but not in VATS.…”

Section: Discussionmentioning

confidence: 99%

Prediction of postoperative pulmonary complications in older patients undergoing lobectomy for lung cancer based on skeletal muscle mass

Hong¹,

Lee²,

Kim³

2023

J Thorac Dis

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Background: This retrospective study was designed to evaluate preoperative pulmonary function test (PFT) results and skeletal muscle mass, represented by the erector spinae muscle (EM), as predictors of postoperative pulmonary complications (PPCs) in older patients undergoing lobectomy for lung cancer. Methods:The medical records, including preoperative PFT, chest computed tomography (CT) and PPCs, of patients older than 65 years undergoing lobectomy for lung cancer were retrospectively examined at Konkuk University Medical Center from January 2016 to December 2021. The sum of cross-sectional areas (CSAs) of the right and left EMs at the level of the spinous process with the 12 th thoracic vertebra was used as the skeletal muscle mass (CSA Both ).Results: Data from a total of 197 patients were included in the analyses. In total, 55 patients had PPCs.The preoperative functional vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) showed significantly poorer values and the CSA Both had significantly lower values in patients with than in those without PPCs. The preoperative FVC and FEV1 showed significant positive correlations with CSA Both .Multiple logistic regression analysis identified age, diabetes mellitus (DM), preoperative FVC and CSA Both as risk factors for PPCs. The areas under the curves for FVC and CSA Both were 0.727 (95% CI, 0.650-0.803; P<0.001) and 0.685 (95% CI, 0.608-0.762; P<0.001), respectively. The optimal threshold values of FVC and CSA Both to predict PPCs based on a receiver operating characteristic curve analysis were 2.685 L (sensitivity =64.1% and specificity =61.8%) and 28.47 mm 2 (sensitivity =62.0% and specificity =61.5%), respectively.Conclusions: PPCs in older patients undergoing lobectomy for lung cancer were associated with lower preoperative FVC and FEV1 values and a lower skeletal muscle mass. Skeletal muscle mass, represented by the EM, was significantly correlated with the preoperative FVC and FEV1. Therefore, skeletal muscle mass may be useful for the prediction of PPCs in patients undergoing lobectomy for lung cancer.

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Preoperative Pulmonary Function Tests (PFTs) and Outcomes from Resected Early Stage Non-small Cell Lung Cancer (NSCLC)

Abstract: Preoperative PFTs did not predict for survival from resected early-stage NSCLC, but did predict for prolonged hospital stay following surgery.

Cited by 10 publications

References 13 publications

The impact of segmentectomy versus lobectomy on pulmonary function in patients with non-small-cell lung cancer: a meta-analysis

The impact of segmentectomy versus lobectomy on pulmonary function in patients with non-small-cell lung cancer: a meta-analysis

Development and validation of nomogram estimating post-surgery hospital stay of lung cancer patients: relevance for predictive, preventive, and personalized healthcare strategies

Prediction of postoperative pulmonary complications in older patients undergoing lobectomy for lung cancer based on skeletal muscle mass

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