Prevalence of and risk factors for pulmonary complications after curative resection in otherwise healthy elderly patients with early stage lung cancer

Abstract

Background and objective: The prevalence of lung cancer has been increasing in healthy elderly patients with preserved pulmonary function and without underlying lung diseases. We aimed to determine the prevalence of and risk factors for postoperative pulmonary complications (PPCs) in healthy elderly patients with non-small cell lung cancer (NSCLC) to select optimal candidates for surgical resection in this subpopulation. Methods: We included 488 patients older than 70 years with normal spirometry results who underwent curative resection for NSCLC (stage IA-IIB) between 2012 and 2016. Results: The median (interquartile range) age of our cohort was 73 (71-76) years. Fifty-two patients (10.7%) had PPCs. Severe PPCs like acute respiratory distress syndrome, pneumonia, and respiratory failure had prevalences of 3.7, 3.7, and 1.4%, respectively. Compared to patients without PPCs, those with PPCs were more likely to be male and current smokers; have a lower body mass index (BMI), higher American Society of Anesthesiologists (ASA) classification, more interstitial lung abnormalities (ILAs), and higher emphysema index on computed tomography (CT); and have undergone pneumonectomy or bilobectomy (all p < 0.05). On multivariate analysis, ASA classification ≥3, lower BMI, ILA, and extent of resection were independently associated with PPC risk. The short-term all-cause mortality was significantly higher in patients with PPCs. Conclusions: Curative resection for NSCLC in healthy elderly patients appeared feasible with 10% PPCs. ASA classification ≥3, lower BMI, presence of ILA on CT, and larger extent of resection are predictors of PPC development, which guide treatment decision-making in these patients.

Intraoperative mechanical ventilation practice in thoracic surgery patients and its association with postoperative pulmonary complications: results of a multicenter prospective observational study

“…In average, 10.7% of patients at increased risk, for example obese patients, developed PPCs [ 29 ]. In patients undergoing thoracic surgery, an incidence of PPCs between 10.7 and 50% has been reported [ 26 , 30 – 32 ]. This relatively wide range is possibly explained by differences in definition of pulmonary complications among trials.…”

Dexmedetomidine for prevention of postoperative pulmonary complications in patients after oral and maxillofacial surgery with fibular free flap reconstruction:a prospective, double-blind, randomized, placebo-controlled trial

“…Moreover, this type of surgery had long surgical time or mechanical ventilation time (mostly more than 3 hours), which might cause ventilation induced lung injury (VILI) 25 , and had limb ischemia-reperfusion injury due to the use of the tourniquet in the thigh area, which might induce remote lung damage 26 . Except that, after the type of surgery, due to the microvascular reconstruction technique in the neck region, patients are required to stay lying in bed restraining lots of neck movement for at least three days after surgery, which might bring about respiratory muscle complications and mouth ejection and even PPCs 27 . Thus, one might expect a high rate of PPCs after oral and maxillofacial surgery, which had been proven in previous studies 5,7,8 .…”

Interstitial Lung Abnormalities: What Radiologists Should Know

“…Despite being often undiagnosed and asymptomatic, ILAs among smokers have been associated with reduced lung volumes ( 10 ), reduced diffusion capacity of carbon monoxide, and reduced exercise capacity ( 11 ). In addition, ILAs are associated with an increased risk of death, specifically death from respiratory failure ( 19 ), poor clinical outcomes in advanced lung cancer ( 28 ), or postoperative complications of major surgeries ( 29 30 ). These results emphasize that it is reasonable to recommend a clinical evaluation to identify any physiologic impairment or an underlying cause of ILD, even if subjects are asymptomatic.…”