MAJOR PULMONARY SURGERY IN PATIENTS WITH COMPROMISED LUNG FUNCTION
DOI:
https://doi.org/10.48729/pjctvs.191Keywords:
respiratory function tests, thoracic surgery, forced expiratory volume, carbon monoxide, risk assessment, lobectomy, pneumonectomyAbstract
Introduction: The risk stratification of lung resection is fundamentally based on the results of pulmonary function tests. In patients considered to be at risk, major surgery is generally denied, opting for potentially less curative therapies.
Objective: To evaluate the postoperative outcomes of major lung surgery in a group of patients deemed high risk. Methods: We performed a retrospective review of clinical records of all patients submitted to lobectomy, bilobectomy or pneumonectomy in a 3-year period in a reference Thoracic Surgery Unit. The patients were then divided in two groups: group A composed of patients with normal preoperative pulmonary function and group B which included patients with impaired lung function, defined as FEV1 and/or DLCO ≤60%.
Results: A total of 234 patients were included, 181 (77.4%) in group A and 53 (22.6%) in group B. In group B, patients had more smoking habits, were more often associated with chronic obstructive pulmonary disease and were also more frequently submitted to thoracotomy. When surgery was motivated by primary lung cancer this group had a more advanced clinical stage of the disease. In the postoperative period, these patients had longer hospital stay, longer chest drainage time and greater need for oxygen therapy at home, however, no statistically significant difference was noted in morbidity or mortality.
Conclusions: Major thoracic surgery can be safely performed in selected patients considered to be high risk for resection by pulmonary function tests. A potentially curative surgery should not be denied based on respiratory function tests alone.
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References
Bongiolatti S, Gonfiotti A, Vokrri E, Borgianni S, Crisci R, Curcio C, Voltolini L. Thoracoscopic lobectomy for nonsmall-cell lung cancer in patients with impaired pulmonary function: analysis from a national database. Interact CardioVascThorac Sur 2020;30:803–11.
Brunelli A, Kim AW, Berger KI, Addrizzo-Harris DJ. Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013;143(5):e166S–e190S (doi:10.1378/chest.12-2395).
Charloux A, Brunelli A, Bolliger CT, Rocco G, Sculier JP, Varela G, Licker M, Ferguson MK, Faivre-Finn C, Huber RM, Clini EM, Win T, De Ruysscher D, Goldman L. Lung function evaluation before surgery in lung cancer patients: how are recent advances put into practice? A survey among members of the European Society of Thoracic Surgeons (ESTS) and of the Thoracic Oncology Section of the European Respiratory Society (ERS). Interactive CardioVascular and Thoracic Surgery 2009;9:925–931.
Brunelli A, Charloux A, Bolliger CT, Rocco G, Sculier JP, Varela G, Licker M, Ferguson MK, Faivre-Finn C, Huber RM, Clini EM, Win T, De Ruysscher D, Goldman L. ERS/ESTS clinical guidelines on fitness forradical therapy in lung cancer patients (surgery and chemo-radiotherapy). Eur Respir J 2009;34(1):17–41.
Subroto P, Weston GA, Abu N, Jeffrey LP, Paul CL, Brendon MS, Nasser KA. Outcomes of lobectomy in patients with severely compromised lung function (predicted postoperative diffusing capacity of the lung for carbon monoxide % ≤ 40%). Ann Am Thorac Soc 2013;10(6):616-621.
Cerfolio RJ, Allen MS, Trastek VF, Deschamps C, Scanlon PD, Pairolero PC. Lung resection in patients with compromised pulmonary function. Ann Thorac Surg 1996;62(2):348-351.
Ceppa DP, Kosinski AS, Berry MF, Tong BC, Harpole DH, Mitchell JD, D'Amico TA, Onaitis MW. Thoracoscopic Lobectomy Has Increasing Benefit in Patients With Poor Pulmonary Function: A Society of Thoracic Surgeons Database Analysis. Ann Surg 2012;256(3):487–493.
Zhang R, Lee SM, Wigfield C, Vigneswaran WT, Ferguson MK. Lung function predicts pulmonary complications
regardless of the surgical approach. Ann Thorac Surg 2015;99:1761–7.
Ferguson MK, Little L, Rizzo L, Popovich KJ, Glonek GF, Leff A, Manjoney D,Little AG. Diffusing capacity predicts morbidity and mortality after pulmonary resection. J Thorac Cardiovasc Surg 1988;96:894–900.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373–383.
Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, Mc-Fadden ET, Carbone PP. Toxicity And Response Criteria Of The Eastern Cooperative Oncology Group. Am J Clin Oncol 1982;5:649-655.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240(2):205-213.
Zhang R, Ferguson MK. Video-Assisted versus Open Lobectomy in Patients with Compromised Lung Function:
A Literature Review and Meta-Analysis. PLoS ONE 2015;10(7):e0124512 (doi:10.1371/journal.pone.0124512).
Linden P, Bueno R, Colson Y, Jaklitsch M, Lukanich J, Mentzer S, Sugarbaker D. Lung Resection in Patients With Preoperative FEV1 < 35% Predicted. Chest 2005;127(6):1984-1990.
Kozower BD, Sheng S, O’Brien SM, Liptay MJ, Lau CL, Jones DR, Shahian DM, Wright CD. STS database risk models: predictors of mortality and major morbidity for lung cancer resection. AnnThoracSurg2010;90:875–881.
Magdeleinat P, Seguin A, Alifano M, Boubia S, Regnard JF. Early and long-term results of lung resection for nonsmall-cell lung cancer in patients with severe ventilatory impairment. European Journal of Cardio-thoracic Surgery 2005;27:1099–1105.
Wei S, Chen F, Liu R, Fu D, Wang Y, Zhang B, Ren D, Ren F, Song Z, Chen J, Xu S. Outcomes of lobectomy on pulmonary function for early stage non-small cell lung cancer (NSCLC) patients with chronic obstructive pulmonary disease (COPD). Thoracic Cancer 2020;11:1784–1789.
