Prevalence and risk factors for postoperative pulmonary complications after lung cancer surgery in patients with early stage of COPD

Kim, Eun Sun; Kim, Young Tae; Kang, Chang Hyun; Park, In Kyu; Bae, Woo Kyung; Choi, Sun Mi; Park, Young Sik; Lee, Chang‐Hoon; Yim, Jae-Joon; Kim, Young Whan; Han, Sung Koo; Yoo, Chul‐Gyu

doi:10.1183/13993003.congress-2016.pa3692

Cited by 13 publications

(13 citation statements)

References 34 publications

(42 reference statements)

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“…In our study, however, the risk of having PPC was not significantly increased in patients with a normal DLco before CCRT, regardless of deterioration in DLco after CCRT. Moreover, patients with a consistently normal range DLco both before and after CCRT had less than a 10% incidence of PPC, which is comparable to those in early-stage NSCLC patients who had surgery without neoadjuvant treatment [20,21]. In other words, the results of our study indicate that neoadjuvant CCRT followed by surgery could have acceptable morbidity in patients with a normal DLco both before and after CCRT.…”

Section: Discussionsupporting

confidence: 70%

Impact of diffusing lung capacity before and after neoadjuvant concurrent chemoradiation on postoperative pulmonary complications among patients with stage IIIA/N2 non-small-cell lung cancer

et al. 2020

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Background and objective: This study aims to evaluate the impact of diffusing capacity of the lung for carbon monoxide (DLco) before and after neoadjuvant concurrent chemoradiotherapy (CCRT) on postoperative pulmonary complication (PPC) among stage IIIA/N2 non-small-cell lung cancer (NSCLC) patients. Methods:We retrospectively studied 324 patients with stage IIIA/N2 NSCLC between 2009 and 2016. Patients were classified into 4 groups according to DLco before and after neoadjuvant CCRT; normal-to-normal (NN), normal-tolow (NL), low-to-low (LL), and low-to-very low (LVL). Low DLco and very low DLco were defined as DLco < 80% predicted and DLco < 60% predicted, respectively. Results: On average, DLco was decreased by 12.3% (±10.5) after CCRT. In multivariable-adjusted analyses, the incidence rate ratio (IRR) for any PPC comparing patients with low DLco to those with normal DLco before CCRT was 2.14 (95% confidence interval (CI) = 1.36-3.36). Moreover, the IRR for any PPC was 3.78 (95% CI = 1.68-8.49) in LVL group compared to NN group. The significant change of DLco after neoadjuvant CCRT had an additional impact on PPC, particularly after bilobectomy or pneumonectomy with low baseline DLco.Conclusions: The DLco before CCRT was significantly associated with risk of PPC, and repeated test of DLco after CCRT would be helpful for risk assessment, particularly in patients with low DLco before neoadjuvant CCRT.

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Section: Discussionsupporting

confidence: 70%

Impact of diffusing lung capacity before and after neoadjuvant concurrent chemoradiation on postoperative pulmonary complications among patients with stage IIIA/N2 non-small-cell lung cancer

et al. 2020

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“…Whereas PR improves the functional parameters responsible for inoperability, the selection criteria for enrolling patients in PR are still controversial. A recent study demonstrated that, even in patients with early‐stage COPD, the prevalence of postoperative pulmonary complications was higher than in NSCLC patients with normal spirometry . In the present retrospective review, the non‐PR group included stage I COPD.…”

Section: Discussionmentioning

confidence: 89%

“…Previously published studies have shown COPD to be a well‐known risk factor for postoperative pulmonary complications . Whereas PR improves the functional parameters responsible for inoperability, the selection criteria for enrolling patients in PR are still controversial.…”

Section: Discussionmentioning

confidence: 99%

Impact of pulmonary rehabilitation on postoperative complications in patients with lung cancer and chronic obstructive pulmonary disease

et al. 2017

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BackgroundGiven the extent of the surgical indications for pulmonary lobectomy in breathless patients, preoperative care and evaluation of pulmonary function are increasingly necessary. The aim of this study was to assess the contribution of preoperative pulmonary rehabilitation (PR) for reducing the incidence of postoperative pulmonary complications in non‐small cell lung cancer (NSCLC) patients with chronic obstructive pulmonary disease (COPD).MethodsThe records of 116 patients with COPD, including 51 patients who received PR, were retrospectively analyzed. Pulmonary function testing, including slow vital capacity (VC) and forced expiratory volume in one second (FEV 1), was obtained preoperatively, after PR, and at one and six months postoperatively. The recovery rate of postoperative pulmonary function was standardized for functional loss associated with the different resected lung volumes. Propensity score analysis generated matched pairs of 31 patients divided into PR and non‐PR groups.ResultsThe PR period was 18.7 ± 12.7 days in COPD patients. Preoperative pulmonary function was significantly improved after PR (VC 5.3%, FEV 1 5.5%; P < 0.05). The FEV 1 recovery rate one month after surgery was significantly better in the PR (101.6%; P < 0.001) than in the non‐PR group (93.9%). In logistic regression analysis, predicted postoperative FEV 1, predicted postoperative %FEV 1, and PR were independent factors related to postoperative pulmonary complications after pulmonary lobectomy (odds ratio 18.9, 16.1, and 13.9, respectively; P < 0.05).Conclusions PR improved the recovery rate of pulmonary function after lobectomy in the early period, and may decrease postoperative pulmonary complications.

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“…Pulmonary function has been reported to improve from 3 to 12 months after lobectomy; however, FEV 1 and %DLCO at 12 months after lobectomy were still lower than pre-operative values (12). After lung resection, alterations of pulmonary function are in turn implicated in the development of postoperative complications, which are among the foremost causes of mortality (23). In addition, COPD patients sometimes suffer acute exacerbations which worsen pulmonary function (24).…”

Section: Discussionmentioning

confidence: 99%

Comparison between quantitative computed tomography, scintigraphy, and anatomical methods for prediction of postoperative FEV1 and DLCO: effects of chronic obstructive pulmonary disease status and resected lobes

Yokoba¹,

Ichikawa²,

Harada³

et al. 2020

J Thorac Dis

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Background: Postoperative assessment of pulmonary function is important for estimating the risk of thoracic surgery and long-term disability following pulmonary resection, including predicted postoperative (ppo) forced expiratory volume (FEV) in one second (ppoFEV 1 ) and percent predicted lung diffusion capacity for carbon monoxide (ppo%DLCO) estimation. The ppo values were compared using four different estimation methods between chronic obstructive pulmonary disease (COPD) and non-COPD patients and according to the resected lobe. Methods: This prospective study included 59 eligible patients requiring single lobectomy and succeeded in performing pulmonary function tests at 3 and 12 months after lobectomy. The ppoFEV 1 and ppo%DLCO were compared with poFEV 1 and po%DLCO obtained at 3 and 12 months after lobectomy. The ppo values were estimated using the four usual methods: the 19-segment anatomical technique (S), perfusion scintigraphy (Q), quantitative CT (CT), and quantitative CT with low attenuation volume (CT LAV ) subtraction. Results: For non-COPD and COPD patients, the smallest mean difference between ppo and po values was observed by S for FEV 1 and %DLCO. Based on the resected lobe, the smallest mean difference was observed by (I) Q for right upper lobectomy (RUL) excluding %DLCO at 12 months by S, (II) S for left upper lobectomy (LUL), (III) CT and CT LAV for right lower lobectomy (RLL), and (IV) CT and CT LAV for left lower lobectomy (LLL) at 12 months. The ppo values calculated by S for RUL (FEV 1 at 3 and 12 months and %DLCO at 3 months) and by all four methods for LLL (FEV 1 and %DLCO at 3 months) were smaller than the po values. Conclusions: The S method is adequate for calculating ppoFEV 1 and ppo%DLCO when patients are classified as non-COPD and COPD. However, S sometimes overestimates the ppoFEV 1 and ppo%DLCO when patients are classified according to the resected lobe. The CT LAV method may be the method of choice instead of S for calculating ppoFEV 1 and ppo%DLCO in patients who undergo lung lobectomy despite the presence or absence of airflow limitation.

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Prevalence and risk factors for postoperative pulmonary complications after lung cancer surgery in patients with early stage of COPD

Cited by 13 publications

References 34 publications

Impact of diffusing lung capacity before and after neoadjuvant concurrent chemoradiation on postoperative pulmonary complications among patients with stage IIIA/N2 non-small-cell lung cancer

Impact of diffusing lung capacity before and after neoadjuvant concurrent chemoradiation on postoperative pulmonary complications among patients with stage IIIA/N2 non-small-cell lung cancer

Impact of pulmonary rehabilitation on postoperative complications in patients with lung cancer and chronic obstructive pulmonary disease

Comparison between quantitative computed tomography, scintigraphy, and anatomical methods for prediction of postoperative FEV1 and DLCO: effects of chronic obstructive pulmonary disease status and resected lobes

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