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

Abstract

PurposeThis study aimed to investigate whether the prevalence of postoperative pulmonary complications (PPCs) in patients with non-small-cell lung cancer (NSCLC) is even higher in the early stages of COPD than in such patients with normal lung function and to verify the usefulness of symptom- or quality of life (QoL)-based scores in predicting risk for PPCs.Patients and methodsPatients undergoing pulmonary resection for NSCLC between July 2012 and October 2014 were prospectively enrolled. Preoperative measurements of lung function, dyspnea, and QoL, operative characteristics, PPCs, duration of postoperative hospitalization, and in-hospital mortality were assessed.ResultsAmong 351 consecutive patients with NSCLC, 343 patients with forced expiratory volume in 1 second (FEV1) ≥70% of predicted value were enrolled. At least one PPC occurred in 57 (16.6%) patients. Prevalence of PPC was higher in patients with COPD (30.1%) than in those with normal spirometry (10.0%; P<0.001). However, in patients with COPD, the prevalence of PPC was not different in patients with FEV1 ≥70% compared to those with FEV1 <70% and between group A (low risk and less symptoms) and group B (low risk and more symptoms) patients with COPD, based on the new Global initiative for chronic Obstructive Lung Disease 2011 guidelines. In patients with COPD, body mass index (odds ratio [OR]: 0.80, P=0.007), carbon monoxide diffusing capacity of the lung (DLCO), % predicted value (OR: 0.97, P=0.024), and operation time (OR: 1.01, P=0.003), but not COPD assessment test or St George Respiratory Questionnaire scores, were significantly associated with PPCs.ConclusionEven in patients with early-stage COPD, the prevalence of PPCs is higher than in patients with NSCLC with normal spirometry. However, this rate is not different between group A and group B patients with COPD. In accordance with this, scores based on symptoms or QoL are not predictors of risk of PPCs in patients with early-stage COPD.

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

“…Previously published studies have shown COPD to be a well-known risk factor for postoperative pulmonary complications. 28,29 Whereas PR improves the functional parameters responsible for inoperability, 22 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.…”

“…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. 29 In the present retrospective review, the non-PR group included stage I COPD. Our finding that PR reduced postoperative pulmonary complications may indicate that PR should be performed even at stage I COPD.…”

Lung cancer and chronic obstructive pulmonary disease: From a clinical perspective

“…Furthermore, the frequencies of all postoperative pulmonary complications (PPCs), including pneumonia (10.1%-16.2% in COPD patients following lung cancer surgery) [77–79], atelectasis (3.5%-15.4%) [79, 80], empyema (2.2%-8.3%) [78], and persistent air leak (12%-16.2%) [77, 81], were often higher in COPD patients. Therefore, an accurate risk assessment in patients with lung cancer coexisting with COPD is critically important, in order to optimize treatment for these patients.…”

Lobectomy for non-small cell lung carcinoma: a nationwide study of short- and long-term survival

“…Most studies on pulmonary resections for NSCLC -and especially lobectomy -have focused more on short-term outcome than on long-term survival [12,13]. These studies have usually been based on single tertiary-care centers, with the risk of selection bias.…”