Original articleGeneral thoracicLung Function Predicts Pulmonary Complications Regardless of the Surgical Approach
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
References (27)
- et al.
Diffusing capacity predicts morbidity after lung resection in patients without obstructive lung disease
Ann Thorac Surg
(2008) - et al.
Efficacy of mediastinal lymph node dissection during lobectomy for lung cancer by thoracoscopy and thoracotomy
Ann Thorac Surg
(2011) - et al.
Lobectomy by video-assisted thoracic surgery (VATS) versus thoracotomy for lung cancer
J Thorac Cardiovasc Surg
(2009) - et al.
Pulmonary function, postoperative pain, and serum cytokine level after lobectomy: a comparison of VATS and conventional procedure
Ann Thorac Surg
(2001) - et al.
Pulmonary function tests do not predict pulmonary complications after thoracoscopic lobectomy
Ann Thorac Surg
(2010) - et al.
Pulmonary complications after lung resection in the absence of chronic obstructive pulmonary disease: the predictive role of diffusing capacity
J Thorac Cardiovasc Surg
(2009) - et al.
Thoracoscopic lobectomy is associated with lower morbidity than open lobectomy: a propensity-matched analysis from the STS database
J Thorac Cardiovasc Surg
(2010) - et al.
Impact of hospital volume of thoracoscopic lobectomy on primary lung cancer outcomes
Ann Thorac Surg
(2012) - et al.
Fewer complications result from a video-assisted approach to anatomic resection of clinical stage I lung cancer
J Thorac Cardiovasc Surg
(2014) - et al.
Video-assisted thoracic surgery pulmonary resection for lung cancer in patients with poor lung function
Ann Thorac Surg
(2006)
Perioperative outcomes of thoracoscopic anatomic resections in patients with limited pulmonary reserve
J Thorac Cardiovasc Surg
Predictors of early morbidity after major lung resection in patients with and without airflow limitation
Ann Thorac Surg
State-of-the-art radiological techniques improve the assessment of postoperative lung function in patients with non-small cell lung cancer
Eur J Radiol
Cited by (32)
Commentary on impact of pulmonary function on robotic pulmonary resection
2021, Laparoscopic, Endoscopic, and Robotic SurgeryDeterioration in Health-Related Quality of Life Diminishes Benefit of Lung Cancer Resection in Older Adults
2021, Clinical Lung CancerCitation Excerpt :This consideration is further compounded by the changes in lung function with aging, including decreased functional reserve capacity and decreased lung compliance.7,8 Pulmonary function testing provides a good assessment of such measures but provides an incomplete picture of a patient’s appropriateness for lung resection.9,10 Patient-centered outcomes, such as health-related quality of life (HRQOL), provide a more complete characterization of a patient’s overall fitness.
Tailored anaesthesia for thoracoscopic surgery promoting enhanced recovery: The state of the art
2021, Anaesthesia Critical Care and Pain MedicineCitation Excerpt :According to both the American College of Chest Physicians (ACCP) and the British Thoracic Society (BTS), spirometry testing measuring the forced expiratory volume in one second (FEV1) is always recommended in patients planned for pulmonary resection [7,8]. In patients with a normal FEV1, the “diffusing capacity of the lung for carbon monoxide (DLCO)” is established for predicting postoperative complications [9]. A reduced ppo DLCO correlates most accurately with the risk of postoperative pulmonary complications and mortality following lung resection.
Wedge Resection, Lobectomy, Pneumonectomy
2021, Cohen's Comprehensive Thoracic Anesthesia