Risk of postoperative complications in chronic obstructive lung diseases patients considered fit for lung cancer surgery: beyond oxygen consumption

Shafiek, Hanaa; Valera, José Luis; Togores, Bernat; Torrecilla, Juan Antonio; Sauleda, Jaume; Cosío, Borja G.

doi:10.1093/ejcts/ezw104

Cited by 46 publications

(48 citation statements)

References 24 publications

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“…In our specialty, previous reports have shown that patients with VE/V CO2 slope exceeding 35 had a significant higher incidence of respiratory complications and mortality after major pulmonary resection, while VO2 max was not associated with respiratory complications [9]. Moreover, some reports [10][11][12], which were almost consistent with our previous results [9], demonstrated the efficacy and importance of 4 4 VE/V CO2 slope for predicting surgical complications in patients with chronic obstructive pulmonary disease (COPD).…”

Section: Introductionsupporting

confidence: 90%

“…Torchio [11] et al adopted the cut-off of >34 as used in heart failure patients. Shafiek et al [10] also determined cut-off value of VE/V CO2 slope as >35 for predicting postoperative complications. However, they included patients submitted to pneumonectomy, who in our opinion represent a different group of patients and analysed separately from lesser resections for the higher physiologic burden imposed by that operation.…”

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confidence: 99%

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Minute ventilation-to-carbon dioxide slope is associated with postoperative survival after anatomical lung resection

et al. 2018

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Objectives:The aim of the study was to identify whether ventilation-to-carbon dioxide output (VE/V CO2) slope obtained from cardiopulmonary exercise test (CPET) as part of the preoperative functional workup was an independent prognostic factor for short and long-term survival after major lung resection. Patients and Methods: 974 consecutive patients undergoing lobectomy (n=887) or segmentectomy (n=87) between April 2014 to March 2018 were included. 209 (22%) underwent CPET, and pulmonary function tests and several clinical factors including age, sex, performance status and comorbidities were retrospectively investigated to identify the prognostic factors with a multivariable Cox regression analysis.Results: Among the patients with measured VE/V CO2, the incidence of cardiopulmonary complications in patients with high VE/V CO2 slope (>40) was 37% (19 of 51) vs. 27% (33 of 121) in those with lower slope values (p=0.19). The 90-day mortality in patients with high VE/V CO2 slope (n=8) was 16% vs. 5% (n=6) in those with lower slope values (p=0.03). No overall difference in 2-year mortality was identified between the two groups (VE/VCO2 >40: 70% (54-80) vs. VE/VCO2 ≤40: 72% (63-80), log-rank test, p=0.39). In a Cox regression analysis VE/VCO2 values were associated with poorer 2-year survival (HR 1.05, 95% CI 1.01-1.10, p=0.030). Conclusions:We found that VE/V CO2 slope was an independent prognostic factor for the 90-day mortality and 2-year survival after anatomic pulmonary resection. This finding may assist during the multidisciplinary treatment decision-making process in high-risk patients with lung cancer.

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Section: Introductionsupporting

confidence: 90%

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confidence: 99%

Minute ventilation-to-carbon dioxide slope is associated with postoperative survival after anatomical lung resection

et al. 2018

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“…Resting pulmonary function tests and, to a lesser extent, peak O 2 uptake (V′O 2 ) [99] have been used to assess perioperative risk in these patients. There is mounting evidence that a high V′E−V′CO 2 slope is also a powerful predictor of poor surgical outcome for lung resection surgery [46][47][48], likely superior to peak V′O 2 [48]. In this context, a high V′E−V′CO 2 slope might indicate greater VD due to more extensive emphysema and/or high pulmonary vascular pressures, poorer cardiac performance, higher sympathetic drive, worse exertional hypoxemia and greater ergorreceptor stimulation [100].…”

Section: Risk Assessment and Prognosismentioning

confidence: 99%

“…In this context, a high V′E−V′CO 2 slope might indicate greater VD due to more extensive emphysema and/or high pulmonary vascular pressures, poorer cardiac performance, higher sympathetic drive, worse exertional hypoxemia and greater ergorreceptor stimulation [100]. Of note, however, few patients with severe to very severe COPD (who usually present with lower V′E−V′CO 2 slopes) (figure 2) undergo extensive lung resection surgery and/or pre-operative CPET [46][47][48]. Thus, it remains to be investigated whether a low V′E−V′CO 2 slope predicts poor outcome in selected patients who despite severe to very severe airflow obstruction are potential candidates for resection, e.g.…”

Section: Risk Assessment and Prognosismentioning

confidence: 99%

“…Thus, single- [51] and double-lung [61] transplantation and lung volume reduction surgery [63,66] lessened VD and increased VT thereby reducing VD/VT with consequent benefits to ventilatory efficiency. This suggests that the marked effects of these interventions on VD/VT (which would lessen V′E) relatively outweighed the consequences of lower mechanical constraints, which would otherwise increase V′E [39,[46][47][48][49][98][99][100]. Lower neural drive (e.g.…”

Section: Effects Of Interventionsmentioning

confidence: 99%

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Physiological and clinical relevance of exercise ventilatory efficiency in COPD

et al. 2017

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Exercise ventilation (') relative to carbon dioxide output (' ) is particularly relevant to patients limited by the respiratory system, those with chronic obstructive pulmonary disease (COPD). High'-' (poor ventilatory efficiency) has been found to be a key physiological abnormality in symptomatic patients with largely preserved forced expiratory volume in 1 s (FEV). Establishing an association between high '-' and exertional dyspnoea in mild COPD provides evidence that exercise intolerance is not a mere consequence of detraining. As the disease evolves, poor ventilatory efficiency might help explaining "out-of-proportion" breathlessness (to FEV impairment). Regardless, disease severity, cardiocirculatory co-morbidities such as heart failure and pulmonary hypertension have been found to increase '-' In fact, a high '-' has been found to be a powerful predictor of poor outcome in lung resection surgery. Moreover, a high '-' has added value to resting lung hyperinflation in predicting all-cause and respiratory mortality across the spectrum of COPD severity. Documenting improved ventilatory efficiency after lung transplantation and lung volume reduction surgery provides objective evidence of treatment efficacy. Considering the usefulness of exercise ventilatory efficiency in different clinical scenarios, the '-' relationship should be valued in the interpretation of cardiopulmonary exercise tests in patients with mild-to-end-stage COPD.

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Thoracic Surgery

Batchelor¹

2020

Enhanced Recovery After Surgery

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Risk of postoperative complications in chronic obstructive lung diseases patients considered fit for lung cancer surgery: beyond oxygen consumption

Abstract: VO is not the unique parameter to consider when CPET is performed to evaluate the postoperative risk of lung cancer surgery in COPD patients. The signs of ventilatory inefficiency such as VE/VCO slope predict complications better than VO does.

Cited by 46 publications

References 24 publications

Minute ventilation-to-carbon dioxide slope is associated with postoperative survival after anatomical lung resection

Minute ventilation-to-carbon dioxide slope is associated with postoperative survival after anatomical lung resection

Physiological and clinical relevance of exercise ventilatory efficiency in COPD

Thoracic Surgery

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