Original article
General thoracic
Lung Function Predicts Pulmonary Complications Regardless of the Surgical Approach

Presented at the Sixty-first Annual Meeting of the Southern Thoracic Surgical Association, Tucson, AZ, Nov 5–8, 2014.
https://doi.org/10.1016/j.athoracsur.2015.01.030Get rights and content

Background

Although postoperative predicted forced expiratory volume in the first second and diffusing capacity of lung (ppoFEV1% and ppoDLCO%, respectively) have been identified as independent predictors of postoperative pulmonary complications after open lobectomy, it has been suggested that their predictive abilities may not extend to patients undergoing minimally invasive lobectomy.

Methods

We evaluated outcomes in 805 patients undergoing isolated lobectomy through open (n = 585) or minimally invasive approaches (n = 220) using a prospective database. Demographic and physiologic data were extracted and compared with complications classified as pulmonary, cardiac, other, mortality, and any.

Results

Patients included 428 women and 377 men; mean age was 65.0 years. Minimally invasive patients were older (66.6 versus 64.3 years, p = 0.006), had better ppoFEV1% (71.5% versus 65.6%, p < 0.001) and performance status (0,1 94.1% versus 88.4%, p = 0.017), and less often underwent induction therapy (0.5% versus 4.8%, p = 0.003). Pulmonary and other complications were less common after minimally invasive lobectomy (3.6% versus 10.4%, p = 0.0034; 8.6% versus 15.8%, p = 0.008). Operative mortality occurred in 1.4% of minimally invasive patients and 3.9% of open patients (p = 0.075). Pulmonary complication incidence was related to predicted postoperative lung function for both minimally invasive and open approaches. On multivariate analysis with stratification for stage, ppoFEV1% and ppoDLCO% were predictive of pulmonary complications for both minimally invasive and open approaches.

Conclusions

Our results suggest that the predictive abilities of ppoFEV1% and ppoDLCO% are retained for minimally invasive lobectomy and can be used to estimate the risk of pulmonary complications.

Section snippets

Patients and Methods

A retrospective study was performed using the prospective database of the thoracic surgery service at University of Chicago Medicine. All patients undergoing elective isolated lobectomy for cancer or benign disease from 1994 through 2013 were included and were divided into two groups according to the ultimate surgical approach: open thoracotomy and minimally invasive (either VATS or robotic-assisted VATS). This study was approved by the Institutional Review Board, and specific patient consent

Results

From 1994 through 2013, 805 patients underwent isolated lobectomy. There were 428 women and 377 men with a mean age of 65 years. An open thoracotomy approach was applied in 585 patients, whereas a minimally invasive approach was used in 220 patients, including VATS (198) and robotic techniques (22). Patient demographics and clinical characteristics are listed in Table 1. The patients in the minimally invasive group were older, were more likely to be female, had more early stage disease, had

Comment

Risk assessment is important in identifying patients who are at increased odds for mortality and morbidity after major lung resection. The FEV1%, DLCO%, and their predicted postoperative values are among the most useful predictors of postoperative pulmonary complications 3, 12, 13. Their predictive ability was established almost exclusively from datasets of patients undergoing open lung resections 1, 2, 3, 13. In the last decade, minimally invasive approaches, especially VATS lobectomy, have

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