Lung cancer resection: The prediction of postsurgical outcomes should include long-term functional results

M. Beccaria, A. Corsico, P. Fulgoni, M. C. Zoia, L. Casali, G. Orlandoni, I. Cerveri

Research output: Contribution to journalArticle

Abstract

Study objectives: To assess (1) the possibility of predictin long-term postoperative lung function, and (2) the usefulness of maximal oxygen consumption (VO2max) as a criterion for operability and as a predictor of long-term disability. Design: Prospective study. Setting: Outpatients and inpatients of a university hospital. Participants: Sixty-two consecutive patients (mean ± SD age, 62 ± 8 years; 51 male and 11 female patients) were preoperatively evaluated for lung cancer resection (pneumonectomy or bilobectomy [n = 14] and lobectomy [n = 48]). Measurements: Clinical examination and recorded respiratory symptoms and spirometry results before surgery and 6 months after surgery. If predicted postoperative FEV1 (ppoFEV1) was <40%, patients underwent exercise testing; if VO2max was between 10 mL/kg/min and 20 mL/kg/min, patients underwent a split-function study. Results: All the patients with ppoFEV1 ≥ 40% - even those patients (26%) with FEV1 <80% - underwent thoracotomy without further tests. Seven patients with ppoFEV1 <40% underwent exercise testing, and three of them underwent a split-function study. Nine patients (15%; including six patients with COPD and one patient with asthma) had immediate postoperative complications (pneumonia [n = 5] and respiratory failure [n = 4]); seven of these patients had ppoFEV1 > 40%. ppoFEV1 significantly underestimated the actual postoperative FEV1 (poFEV1; p <0.001) 6 months after pneumonectomy or bilobectomy but was reliable for actual poFEV1 after lobectomy. Two patients with predicted postoperative VO2max > 10 mL/kg/min became oxygen dependent and had marked limitation of daily living. Conclusions: ppoFEV1 > 40% reliably identifies patients not requiring further tests and not at long-term risk of respiratory disability. VO2max, effective for defining the immediate surgical risk, is not useful in predicting long-term disability.

Original languageEnglish
Pages (from-to)37-42
Number of pages6
JournalChest
Volume120
Issue number1
DOIs
Publication statusPublished - 2001

Keywords

  • Lung neoplasms
  • Postoperative complications
  • Respiratory funct on tests
  • Thoracotomy

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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