Original article
General thoracic
Pulmonary Function Tests Do Not Predict Pulmonary Complications After Thoracoscopic Lobectomy

Presented at the Fifth-sixth Annual Meeting of the Southern Thoracic Surgical Association, Marco Island, FL, Nov 4–7, 2009.
https://doi.org/10.1016/j.athoracsur.2009.12.065Get rights and content

Background

Pulmonary function tests predict respiratory complications and mortality after lung resection through thoracotomy. We sought to determine the impact of pulmonary function tests upon complications after thoracoscopic lobectomy.

Methods

A model for morbidity, including published preoperative risk factors and surgical approach, was developed by multivariable logistic regression. All patients who underwent lobectomy for primary lung cancer between December 1999 and October 2007 with preoperative forced expiratory volume in 1 second (FEV1) or diffusion capacity to carbon monoxide (Dlco) 60% or less predicted were reviewed. Preoperative, histopathologic, perioperative, and outcome variables were assessed using standard descriptive statistics. Pulmonary complications were defined as atelectasis requiring bronchoscopy, pneumonia, reintubation, and tracheostomy.

Results

During the study period, 340 patients (median age 67) with Dlco or FEV1 60% or less (mean % predicted FEV1, 55 ± 1; mean % predicted Dlco, 61 ± 1) underwent lobectomy (173 thoracoscopy, 167 thoracotomy). Operative mortality was 5% (17 patients) and overall morbidity was 48% (164 patients). At least one pulmonary complication occurred in 57 patients (17%). Significant predictors of pulmonary complications by multivariable analysis for all patients included Dlco (odds ratio 1.03, p = 0.003), FEV1 (odds ratio 1.04, p = 0.003), and thoracotomy as surgical approach (odds ratio 3.46, p = 0.0007). When patients were analyzed according to operative approach, Dlco and FEV1 remained significant predictors of pulmonary morbidity for patients undergoing thoracotomy but not thoracoscopy.

Conclusions

In patients with impaired pulmonary function, preoperative pulmonary function tests are predictors of pulmonary complications when lobectomy for lung cancer is performed through thoracotomy but not through thoracoscopy.

Section snippets

Patients and Methods

After local Institutional Review Board approval was granted, including waiver of the need for patient consent, the Duke University Medical Center Data Center was queried for Current Procedural Terminology codes linked with pulmonary resection by either an open approach or by a thoracoscopic approach between December 1999 and October 2007. Eligibility for this study was restricted to patients who underwent anatomic lobectomy for lung cancer with pulmonary function testing demonstrating either

Results

Lobectomy was performed for lung cancer in 943 patients overall during the study period; 340 of these patients (median age of 67) had either Dlco or FEV1 60% or less (mean % predicted FEV1, 55 ± 1; mean % predicted Dlco, 61 ± 1). Of these 340 patients, 167 patients had lobectomy through thoracotomy and 173 patients through thoracoscopy. Eight patients who underwent an initial attempt at lobectomy through thoracoscopy (4.4% of all patients who underwent attempted thoracoscopic lobectomy)

Comment

Preoperative PFTs are probably the most important tool available to surgeons in evaluating the risk of patients under consideration for major lung resection [3, 4, 5, 6, 7, 8]. The FEV1 and Dlco are the PFT parameters most useful in assessing risk of postoperative morbidity, pulmonary complications, respiratory failure, and death, although there is no general agreement on the individual predictive value of the parameters or the limits beyond which lung resection should not be performed [9, 10,

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