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Dankert A, Neumann-Schirmbeck B, Dohrmann T, Plümer L, Wünsch VA, Sasu PB, Sehner S, Zöllner C, Petzoldt M. Stair-Climbing Tests or Self-Reported Functional Capacity for Preoperative Pulmonary Risk Assessment in Patients with Known or Suspected COPD-A Prospective Observational Study. J Clin Med 2023; 12:4180. [PMID: 37445215 DOI: 10.3390/jcm12134180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/14/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND This prospective study aims to determine whether preoperative stair-climbing tests (SCT) predict postoperative pulmonary complications (PPC) better than self-reported poor functional capacity (SRPFC) in patients with known or suspected COPD. METHODS A total of 320 patients undergoing scheduled for major non-cardiac surgery, 240 with verified COPD and 80 with GOLD key indicators but disproved COPD, underwent preoperative SRPFC and SCT and were analyzed. Least absolute shrinkage and selection operator (LASSO) regression was used for variable selection. Two multivariable regression models were fitted, the SRPFC model (baseline variables such as sociodemographic, surgical and procedural characteristics, medical preconditions, and GOLD key indicators plus SRPFC) and the SCT model (baseline variables plus SCTPFC). RESULTS Within all stair-climbing variables, LASSO exclusively selected self-reported poor functional capacity. The cross-validated area under the receiver operating characteristic curve with bias-corrected bootstrapping 95% confidence interval (95% CI) did not differ between the SRPFC and SCT models (0.71; 0.65-0.77 for both models). SRPFC was an independent risk factor (adjusted odds ratio (OR) 5.45; 95% CI 1.04-28.60; p = 0.045 in the SRPFC model) but SCTPFC was not (adjusted OR 3.78; 95% CI 0.87-16.34; p = 0.075 in the SCT model). CONCLUSIONS Our findings indicate that preoperative SRPFC adequately predicts PPC while additional preoperative SCTs are dispensable in patients with known or suspected COPD.
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Affiliation(s)
- André Dankert
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Benedikt Neumann-Schirmbeck
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Thorsten Dohrmann
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Lili Plümer
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Viktor Alexander Wünsch
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Phillip Brenya Sasu
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Susanne Sehner
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Christian Zöllner
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Martin Petzoldt
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
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Fukui M, Matsunaga T, Hattori A, Takamochi K, Oh S, Nojiri S, Suzuki K. Exercise oxygen desaturation is a predictor of cardiopulmonary complications after lung resection. BMJ Open Respir Res 2022; 9:9/1/e001397. [PMID: 36600400 PMCID: PMC9748966 DOI: 10.1136/bmjresp-2022-001397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/29/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND To investigate whether oxygen desaturation during low technology tests was associated with complications after lung resection. METHODS A retrospective cohort study was conducted on 1097 candidates for pulmonary resection; seven metabolic equivalents in the Master's double two-step test were loaded. The predicted postoperative (PPO) forced expiratory volume in 1 s and PPO diffusing capacity of the lung for carbon monoxide were estimated. The patients were divided into three groups: those with both values ≥60% (≥60% group (n=298)), either value <30% (<30% group (n=112)) and others (30%-60% group (n=687)). The relationships between postoperative cardiopulmonary complications and exercise stress test based on availability, symptoms and percutaneous oxygen saturation values were investigated in each group. RESULTS Τhe cardiopulmonary morbidity rates in the ≥60%, 30%-60%, and <30% groups were 7.7%, 14.6%, and 47.3%, respectively. Multivariate analyses revealed that predictors of complications were age (OR 0.96; p<0.001), male sex (OR 1.74; p=0.016) and exercise oxygen desaturation (EOD) >4% (OR 2.39; p=0.001) in the 30%-60% group, and male sex (OR 3.76; p=0.042) and EOD >4% (OR 2.28; p=0.030) in the <30% group.The two-flight test (TFT) was performed in 181 patients (22.8%); desaturation >4% in the TFT was also a predictor of complications. CONCLUSIONS A low technology test is also valuable for high-risk patients. EOD >4% is a predictor of postoperative complications. CLINICAL REGISTRATION This study is a non-interventional observational study and has not been registered in a public database. The study followed the Strengthening the Reporting of Observational Studies in Epidemiology reporting guidelines.This study was approved by the Ethics Committee of the Juntendo University School of Medicine (no. 2016085).
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Affiliation(s)
- Mariko Fukui
- Department of General Thoracic Surgery, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Takeshi Matsunaga
- Department of General Thoracic Surgery, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Aritoshi Hattori
- Department of General Thoracic Surgery, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Kazuya Takamochi
- Department of General Thoracic Surgery, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Shiaki Oh
- Department of General Thoracic Surgery, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Shuko Nojiri
- Medical Technology Innovation Center, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University, Bunkyo-ku, Tokyo, Japan
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Ho S, Culligan M, Friedberg J, Goloubeva O, Marchese V. Examining the impact of physical function performance in predicting patient outcomes after lung-sparing surgery for malignant pleural mesothelioma. Disabil Rehabil 2022; 44:6676-6683. [PMID: 34455883 DOI: 10.1080/09638288.2021.1970256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE The purpose of this study was to examine the impact of physical function performance and pulmonary function on patient outcomes after lung-sparing surgery for malignant pleural mesothelioma (MPM). MATERIALS AND METHODS A retrospective review of 54 patients with MPM from 2015 to 2020 was performed. The primary objective was to assess whether physical function, as measured by the Eastern Cooperative Oncology Group Performance Status (ECOG), and pulmonary function tests were predictive of postoperative patient outcomes (ventilator days, chest tube days, hospital length of stay). A secondary objective was to explore demographic and preoperative variables that best predict postoperative physical function and patient outcomes. RESULTS Data include 54 patients who underwent extended pleurectomy-decortication. Preoperative ECOG was a significant predictor of postoperative patient outcomes while preoperative lung function lacked predictive ability. Preoperative ECOG was also predictive of preoperative lung function. Age on the day of surgery was the best predictor of postoperative physical function, which was significantly reduced postoperatively. CONCLUSIONS Preoperative physical function performance was a significant predictor of postoperative outcomes. The results of our study highlight the importance of physical function in patients with MPM and support the need for early rehabilitation and further research to determine optimal rehabilitation interventions.IMPLICATIONS FOR REHABILITATIONPreoperative physical function can predict outcomes after lung-sparing surgery for malignant pleural mesothelioma (MPM).Physical function in patients with MPM should be carefully examined.To accurately reflect patients' abilities, patient assessment should include both patient-reported outcomes and performance-based measures.Patients with MPM should receive rehabilitation early after diagnosis and throughout the continuum of care.
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Affiliation(s)
- Simon Ho
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Melissa Culligan
- Division of Thoracic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.,University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
| | - Joseph Friedberg
- Division of Thoracic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.,University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
| | - Olga Goloubeva
- University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA.,Division of Biostatistics and Bioinformation, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Victoria Marchese
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA.,University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
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Schuhan C, Ludwig C. Evaluation der funktionellen Operabilität vor thoraxchirurgischen Eingriffen. Zentralbl Chir 2022; 147:313-328. [DOI: 10.1055/a-1739-9060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Christian Schuhan
- Klinik für Thoraxchirurgie, Florence-Nightingale-Krankenhaus, Akademisches Lehrkrankenhaus der Heinrich-Heine-Universität, Düsseldorf, Deiutschland
| | - Corinna Ludwig
- Klinik für Thoraxchirurgie, Florence-Nightingale-Krankenhaus, Akademisches Lehrkrankenhaus der Heinrich-Heine-Universität, Düsseldorf, Deiutschland
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Lidgard B, Zelnick LR, O’Brien KD, Bansal N. Patient-Reported Symptoms and Subsequent Risk of Myocardial Infarction in Chronic Kidney Disease. Clin J Am Soc Nephrol 2022; 17:487-495. [PMID: 35301197 PMCID: PMC8993476 DOI: 10.2215/cjn.12080921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 02/16/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND OBJECTIVES Although patient-reported symptoms often precede acute presentations of cardiovascular disease, patients with nondialysis-requiring CKD are less likely to have typical symptoms of atherosclerotic disease when presenting with acute myocardial infarction. However, the associations between typical atherosclerotic symptoms and subsequent risk of myocardial infarction are unknown in ambulatory patients with CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS To determine whether typical atherosclerotic symptoms are associated with risk for subsequent myocardial infarction in people with CKD, we examined participants from the Chronic Renal Insufficiency Cohort Study. Chest pain, shortness of breath, and inability to climb stairs were evaluated annually using the Kidney Disease Quality of Life Instrument. Associations between categorical time-updated symptoms and physician-adjudicated incident myocardial infarction were assessed using Cox regression models. RESULTS Among 3910 participants (mean age of 58±11 years; mean eGFR =44±15 ml/min per 1.73 m2), there were 476 incident myocardial infarctions over a median follow-up period of 10.4 years (interquartile range, 5.36-12.6 years). Median time from symptom assessment to incident myocardial infarction was 213 days (interquartile range, 111-333 days). Compared with no symptoms, mild, and moderate or worse, symptoms of chest pain (hazard ratio, 1.30; 95% confidence interval, 1.01 to 1.67; and hazard ratio, 1.70; 95% confidence interval, 1.27 to 2.27, respectively) and shortness of breath (hazard ratio, 1.37; 95% confidence interval, 1.10 to 1.70; and hazard ratio, 1.33; 95% confidence interval, 1.05 to 1.69, respectively) were significantly associated with greater risks for subsequent myocardial infarction. Participants reporting mild and severe limitations in climbing stairs (versus no limitation) had significantly higher adjusted risk of myocardial infarction (hazard ratio, 1.44; 95% confidence interval, 1.10 to 1.89; and hazard ratio, 1.89; 95% confidence interval, 1.44 to 2.49, respectively). CONCLUSIONS In a large ambulatory cohort of adults with CKD, symptoms of atherosclerotic cardiovascular disease were strongly associated with a higher risk for subsequent myocardial infarction. PODCAST This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2022_03_17_CJN12080921.mp3.
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Affiliation(s)
- Benjamin Lidgard
- Department of Medicine, University of Washington, Seattle, Washington
| | - Leila R. Zelnick
- Department of Medicine, University of Washington, Seattle, Washington
| | - Kevin D. O’Brien
- Department of Medicine, University of Washington, Seattle, Washington
| | - Nisha Bansal
- Department of Medicine, University of Washington, Seattle, Washington
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Xiao F, Shao W, Zhang J, Wen H, Guo Y, Liu D, Liang C. The Predictive Value of Stair Climbing Test on Postoperative Complications in Lung Cancer Patients with Limited Pulmonary Function. Ann Thorac Cardiovasc Surg 2022; 28:381-388. [PMID: 36047130 PMCID: PMC9763715 DOI: 10.5761/atcs.oa.22-00034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To evaluate the predictive value of stair climbing test (SCT) on postoperative complications in lung cancer patients with limited pulmonary function. METHODS A total of 727 hospitalized lung cancer patients with limited pulmonary function were retrospectively reviewed. Included in the cohort were 424 patients who underwent SCT preoperatively. Patients were grouped according to general condition, past medical history, surgical approach, pulmonary function test, and SCT results. Comparison of the postoperative cardiopulmonary complication rates was made and independent risk factors were identified. RESULTS A total of 89 cardiopulmonary-related complications occurred in 69 cases, accounting for 16.3% of the entire cohort. The postoperative cardiopulmonary complication rates were significantly different between groups stratified by smoking index, percentage of forced expiratory volume in one second, percentage of diffusion capacity for carbon monoxide, SCT results, excision extension, and anesthetic duration (p <0.05). Multivariate analysis showed that only height achieved (p <0.001), changes in heart rate (∆HR; p <0.001), and excision extension (p = 0.006) were independent risk factors for postoperative cardiopulmonary complications. CONCLUSIONS The SCT could be used as a preoperative screening method for lung cancer patients with limited pulmonary function. For those patients who could only climb less than 6 floors or had ∆HR >30 bpm in the test, sublobar resection should be selected to reduce the postoperative cardiopulmonary complication rate.
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Affiliation(s)
- Fei Xiao
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Weipeng Shao
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, China,Peking University China-Japan Friendship School of Clinical Medicine, Beijng, China
| | - Jin Zhang
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Huanshun Wen
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Yongqing Guo
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Deruo Liu
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Chaoyang Liang
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, China,Corresponding author: Chaoyang Liang. Department of Thoracic Surgery, China-Japan Friendship Hospital, No. 2 Yinghua East Road, Chaoyang District, Beijing 100029, China
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7
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Varghese TK. General Thoracic Surgery. Perioper Med (Lond) 2022. [DOI: 10.1016/b978-0-323-56724-4.00032-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Pennathur A, Brunelli A, Criner GJ, Keshavarz H, Mazzone P, Walsh G, Luketich J, Liptay M, Wafford QE, Murthy S, Marshall MB, Tong B, Lanuti M, Wolf A, Pettiford B, Loo BW, Merritt RE, Rocco G, Schuchert M, Varghese TK, Swanson SJ. Definition and assessment of high risk in patients considered for lobectomy for stage I non-small cell lung cancer: The American Association for Thoracic Surgery expert panel consensus document. J Thorac Cardiovasc Surg 2021; 162:1605-1618.e6. [PMID: 34716030 DOI: 10.1016/j.jtcvs.2021.07.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 06/08/2021] [Accepted: 07/09/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Lobectomy is a standard treatment for stage I non-small cell lung cancer, but a significant proportion of patients are considered at high risk for complications, including mortality, after lobectomy and might not be candidates. Identifying who is at risk is important and in evolution. The objective of The American Association for Thoracic Surgery Clinical Practice Standards Committee expert panel was to review important considerations and factors in assessing who is at high risk among patients considered for lobectomy. METHODS The American Association for Thoracic Surgery Clinical Practice Standards Committee assembled an expert panel that developed an expert consensus document after systematic review of the literature. The expert panel generated a priori a list of important risk factors in the determination of high risk for lobectomy. A survey was administered, and the expert panel was asked to grade the relative importance of each risk factor. Recommendations were developed using discussion and a modified Delphi method. RESULTS The expert panel survey identified the most important factors in the determination of high risk, which included the need for supplemental oxygen because of severe underlying lung disease, low diffusion capacity, the presence of frailty, and the overall assessment of daily activity and functional status. The panel determined that factors, such as age (as a sole factor), were less important in risk assessment. CONCLUSIONS Defining who is at high risk for lobectomy for stage I non-small cell lung cancer is challenging, but remains critical. There was impressive strong consensus on identification of important factors and their hierarchical ranking of perceived risk. The panel identified several key factors that can be incorporated in risk assessment. The factors are evolving and as the population ages, factors such as neurocognitive function and frailty become more important. A minimally invasive approach becomes even more critical in this older population to mitigate risk. The determination of risk is a clinical decision and judgement, which should also take into consideration patient perspectives, values, preferences, and quality of life.
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Affiliation(s)
- Arjun Pennathur
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, and UPMC Hillman Cancer Center, Pittsburgh, Pa.
| | - Alessandro Brunelli
- Department of Thoracic Surgery, St. James University Hospital, Leeds, United Kingdom
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pa
| | - Homa Keshavarz
- The American Association for Thoracic Surgery, Beverly, Mass
| | - Peter Mazzone
- Department of Pulmonology, Cleveland Clinic, Cleveland, Ohio
| | - Garrett Walsh
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass
| | - James Luketich
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, and UPMC Hillman Cancer Center, Pittsburgh, Pa
| | - Michael Liptay
- Department of Thoracic Surgery, University of Texas M.D. Anderson Cancer Center, Houston, Tex
| | | | - Sudish Murthy
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, Ill
| | - M Blair Marshall
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Betty Tong
- Department of Thoracic Surgery, Duke University Hospital, Durham, NC
| | - Michael Lanuti
- Department of Thoracic Surgery, Massachusetts General Hospital, Boston, Mass
| | - Andrea Wolf
- The Icahn School of Medicine at Mount Sinai and Mount Sinai Hospital, New York, NY
| | - Brian Pettiford
- Section of Cardiothoracic Surgery, Ochsner Health System, New Orleans, La
| | - Billy W Loo
- Department of Radiation Oncology & Stanford Cancer Institute, Stanford University School of Medicine, Stanford, Calif
| | - Robert E Merritt
- Division of Thoracic Surgery, The Ohio State University-Wexner Medical Center, Columbus, Ohio
| | - Gaetano Rocco
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Matthew Schuchert
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, and UPMC Hillman Cancer Center, Pittsburgh, Pa
| | - Thomas K Varghese
- Division of Thoracic Surgery, University of Utah, Huntsman Cancer Institute, Salt Lake City, Utah
| | - Scott J Swanson
- Division of Thoracic Surgery, Harvard Medical School and Brigham and Women's Hospital, Boston, Mass.
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Melzer AC, Begnaud A, Lindgren BR, Schertz K, Fu SS, Vock DM, Rothman AJ, Joseph AM. Self-reported exercise capacity among current smokers eligible for lung cancer screening: Distribution and association with key comorbidities. Cancer Treat Res Commun 2021; 28:100443. [PMID: 34371253 PMCID: PMC8405582 DOI: 10.1016/j.ctarc.2021.100443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/22/2021] [Accepted: 07/23/2021] [Indexed: 06/13/2023]
Abstract
ONE CONCERN: as lung cancer screening (LCS) is implemented is that patients will be screened who are too ill to benefit. Poor exercise capacity (EC) predicts adverse outcomes following lung resection. OBJECTIVE Describe the distribution of EC among smokers eligible for LCS and examine associations with comorbidities. METHODS Cross-sectional analysis of baseline data from a randomized controlled trial of tobacco treatment in the context of LCS. Participants responded regarding limitations in moderate activities, ability to climb stairs, and frequency of dyspnea on a scale from never/almost never to all or most of the time. Responses were assigned a numeric score and summed to categorize exercise limitation. Associations between poor EC and key comorbidities were examined using adjusted logistic regression. RESULTS 660 participants completed a survey with the following characteristics: 64.4% male, 89.5% white, mean age 64.5. Overall EC categories were: good 39.0%, intermediate 41.6%, and poor 19.4%. Prevalence of poor EC was higher among patients with COPD (OR 4.62 95%CI 3.05-7.02), heart failure (OR 3.07 95%CI 1.62-5.82) and cardiovascular disease (OR 2.24, 95%CI 1.45-3.47), and was highest among patients with multimorbidity. Among patients with COPD and heart failure, 57% had poor and 0% had good EC. In adjusted logistic regression, only COPD and Charlson comorbidity index remained significantly associated with poor EC. CONCLUSIONS Many patients eligible for LCS reported poor EC, with increased odds of poor EC among patients with comorbidities. More research is needed to determine how to best integrate EC and comorbidity into eligibility and shared decision-making conversations.
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Affiliation(s)
- Anne C Melzer
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, United States; Division of Pulmonary, Allergy, Critical Care and Sleep, University of Minnesota Medical School, United States.
| | - Abbie Begnaud
- Division of Pulmonary, Allergy, Critical Care and Sleep, University of Minnesota Medical School, United States
| | | | - Kelsey Schertz
- Department of Medicine, University of Minnesota Medical School, United States
| | - Steven S Fu
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, United States; Department of Medicine, University of Minnesota Medical School, United States
| | - David M Vock
- Division of Biostatistics, School of Public Health, University of Minnesota, United States
| | | | - Anne M Joseph
- Masonic Cancer Center, University of Minnesota, United States; Department of Medicine, University of Minnesota Medical School, United States
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Hilzenrat RA, Deen SA, Yee J, Grant KA, Ashrafi AS, Coughlin S, McGuire AL. Thoracic Surgeon Impressions of the Impact of the COVID-19 Pandemic on Lung Cancer Care-Lessons from the First Wave in Canada. ACTA ACUST UNITED AC 2021; 28:940-949. [PMID: 33617510 PMCID: PMC7985774 DOI: 10.3390/curroncol28010092] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/24/2021] [Accepted: 02/03/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND COVID-19 has invariably changed the way lung cancer surgical care is provided in Canada. Despite relevant management guidelines, the way in which cancer care has been affected has yet to be described for thoracic surgical populations. Routine lung cancer physiologic and staging assessments are unique in that they are droplet producing and aerosolizing procedures. Our objective was to quantify the effect of the COVID-19 pandemic on surgical lung cancer care as perceived by practicing thoracic surgeons during the first wave of the pandemic in Canada. METHODS An electronic survey was distributed to members of the Canadian Association of Thoracic Surgeons. The survey was designed to determine surgeon perception of lung cancer preoperative care during the Canadian pandemic-instilled period of resource reallocation compared to standard care. Planned analyses were exploratory in nature; with count and frequency distributions of responses quantified. RESULTS Fifty-three thoracic surgeons completed the survey. Responses were collected from all Canadian provinces. Little change in access to preoperative imaging was noted. However, a significant decrease in access to lung function and bronchoscopy testing occurred. Pulmonary surgery was perceived to be lengthier with reduced operating theater availability. Despite decreased OR access, only 40% of surgeons were aware of respective institutional mitigation strategies. SUMMARY The COVID-19 pandemic has had an impact on standard lung cancer care preoperative workup. Further inquiry using institutional data is warranted to quantify its impact on cancer patient outcomes. Assessing the extent and effects of newly present barriers to standard lung cancer care is essential in forming appropriate mitigation strategies and planning for future pandemic waves.
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Affiliation(s)
- Roy A. Hilzenrat
- Department of Surgery, Division of General Surgery, University of British Columbia, Vancouver, BC V5Z 1M9, Canada;
| | - Shaun A. Deen
- Department of Surgery, Division of Thoracic Surgery, University of British Columbia, Vancouver, BC V5Z 1M9, Canada; (S.A.D.); (J.Y.); (K.A.G.); (A.S.A.); (S.C.)
- Department of Surgery, Division of Thoracic Surgery, Interior Health Authority, Kelowna, BC V1Y 1T2, Canada
| | - John Yee
- Department of Surgery, Division of Thoracic Surgery, University of British Columbia, Vancouver, BC V5Z 1M9, Canada; (S.A.D.); (J.Y.); (K.A.G.); (A.S.A.); (S.C.)
- Department of Surgery, Division of Thoracic Surgery, Vancouver Coastal Health Authority, Vancouver, BC V5Z 1M9, Canada
- Vancouver Coastal Health Research Institute, Vancouver, BC V5Z 1M9, Canada
| | - Kyle A. Grant
- Department of Surgery, Division of Thoracic Surgery, University of British Columbia, Vancouver, BC V5Z 1M9, Canada; (S.A.D.); (J.Y.); (K.A.G.); (A.S.A.); (S.C.)
- Department of Surgery, Division of Thoracic Surgery, Vancouver Coastal Health Authority, Vancouver, BC V5Z 1M9, Canada
| | - Ahmad S. Ashrafi
- Department of Surgery, Division of Thoracic Surgery, University of British Columbia, Vancouver, BC V5Z 1M9, Canada; (S.A.D.); (J.Y.); (K.A.G.); (A.S.A.); (S.C.)
- Department of Surgery, Division of Thoracic Surgery, Fraser Health Authority, Surrey, BC V5V 1Z2, Canada
| | - Shaun Coughlin
- Department of Surgery, Division of Thoracic Surgery, University of British Columbia, Vancouver, BC V5Z 1M9, Canada; (S.A.D.); (J.Y.); (K.A.G.); (A.S.A.); (S.C.)
- Department of Surgery, Division of Thoracic Surgery, Island Health Authority, Victoria, BC V8R 1J8, Canada
| | - Anna L. McGuire
- Department of Surgery, Division of Thoracic Surgery, University of British Columbia, Vancouver, BC V5Z 1M9, Canada; (S.A.D.); (J.Y.); (K.A.G.); (A.S.A.); (S.C.)
- Department of Surgery, Division of Thoracic Surgery, Vancouver Coastal Health Authority, Vancouver, BC V5Z 1M9, Canada
- Vancouver Coastal Health Research Institute, Vancouver, BC V5Z 1M9, Canada
- Correspondence: ; Tel.:+1-604-875-5290
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Hanley C, Donahoe L, Slinger P. "Fit for Surgery? What's New in Preoperative Assessment of the High-Risk Patient Undergoing Pulmonary Resection". J Cardiothorac Vasc Anesth 2020; 35:3760-3773. [PMID: 33454169 DOI: 10.1053/j.jvca.2020.11.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 12/21/2022]
Abstract
Advances in perioperative assessment and diagnostics, together with developments in anesthetic and surgical techniques, have considerably expanded the pool of patients who may be suitable for pulmonary resection. Thoracic surgical patients frequently are perceived to be at high perioperative risk due to advanced age, level of comorbidity, and the risks associated with pulmonary resection, which predispose them to a significantly increased risk of perioperative complications, increased healthcare resource use, and costs. The definition of what is considered "fit for surgery" in thoracic surgery continually is being challenged. However, no internationally standardized definition of prohibitive risk exists. Perioperative assessment traditionally concentrates on the "three-legged stool" of pulmonary mechanical function, parenchymal function, and cardiopulmonary reserve. However, no single criterion should exclude a patient from surgery, and there are other perioperative factors in addition to the tripartite assessment that need to be considered in order to more accurately assess functional capacity and predict individual perioperative risk. In this review, the authors aim to address some of the more erudite concepts that are important in preoperative risk assessment of the patient at potentially prohibitive risk undergoing pulmonary resection for malignancy.
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Affiliation(s)
- Ciara Hanley
- Department of Anesthesia and Pain Management, University of Toronto, Toronto General Hospital, Toronto, Ontario, Canada.
| | - Laura Donahoe
- Division of Thoracic Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Peter Slinger
- Department of Anesthesia and Pain Management, University of Toronto, Toronto General Hospital, Toronto, Ontario, Canada
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12
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Rodriguez M. Stair-climbing test: beyond the height. Thorax 2020; 75:716. [PMID: 32651198 DOI: 10.1136/thoraxjnl-2020-214966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Maria Rodriguez
- Department of Thoracic Surgery, Clinica Universidad de Navarra, Madrid, Spain
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13
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Boujibar F, Gillibert A, Gravier FE, Gillot T, Bonnevie T, Cuvelier A, Baste JM. Performance at stair-climbing test is associated with postoperative complications after lung resection: a systematic review and meta-analysis. Thorax 2020; 75:791-797. [PMID: 32651199 PMCID: PMC7476257 DOI: 10.1136/thoraxjnl-2019-214019] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 05/15/2020] [Accepted: 06/05/2020] [Indexed: 12/25/2022]
Abstract
Background Thoracic surgery is the optimal treatment for early-stage lung cancer, but there is a high risk of postoperative morbidity. Therefore, it is necessary to evaluate patients’ preoperative general condition and cardiorespiratory capacity to determine the risk of postoperative complications. The objective of this study was to assess whether the stair-climbing test could be used in the preoperative evaluation of lung resection patients to predict postoperative morbidity following thoracic surgery. Methods We performed a systematic review and a meta-analysis on the association between stair-climbing test result and morbidity/mortality after thoracic surgery. We analysed all articles published until May 2020 in the following databases: Pubmed/Medline, Pedro, The Cochrane library, Embase and CINAHL. The risk of bias was assessed using the Quality in Prognosis Studies tool. This meta-analysis is registered as PROSPERO CRD42019121348. Results 13 articles were included in the systematic review for a total of 2038 patients and 6 in the meta-analysis. There were multiple test evaluation criteria: rise time, height, desaturation and heart rate change. For the meta-analysis, we were able to pool data on the height of rise at a variable threshold: risk ratio 2.34 (95% CI 1.59 to 3.43) with I²=53% (p=0.06). The threshold for occurrence of complications was estimated at a 10 m climb. Conclusions Our results indicate that the stair-climbing test could be used as a first-line functional screening test to predict postoperative morbidity following thoracic surgery and that patients with a poor test result (<10 m) should be referred to formal cardiopulmonary exercise testing.
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Affiliation(s)
- Fairuz Boujibar
- Department of General and Thoracic Surgery, CHU Rouen, Rouen, France .,Normandie University UNIROUEN, INSERM U1096, Rouen, France
| | | | - Francis Edouard Gravier
- ADIR Association, Bois Guillaume, France.,Normandie University, UNIROUEN, UPRES EA 3830, Rouen University Hospital, Haute Normandie Research and Biomedical Innovation, Rouen, France
| | - Timothée Gillot
- CETAPS EA 3832, Mont Saint Aignan, France.,ERFPS, CHU Rouen, Rouen, France
| | - Tristan Bonnevie
- ADIR Association, Bois Guillaume, France.,Normandie University, UNIROUEN, UPRES EA 3830, Rouen University Hospital, Haute Normandie Research and Biomedical Innovation, Rouen, France
| | - Antoine Cuvelier
- Normandie University, UNIROUEN, UPRES EA 3830, Rouen University Hospital, Haute Normandie Research and Biomedical Innovation, Rouen, France.,Pulmonary & Respiratory Intensive Care Department, CHU Rouen, Rouen, Normandie, France
| | - Jean-Marc Baste
- Department of General and Thoracic Surgery, CHU Rouen, Rouen, France.,Normandie University UNIROUEN, INSERM U1096, Rouen, France
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14
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Azzi M, Debeaumont D, Bonnevie T, Aguilaniu B, Cerasuolo D, Boujibar F, Cuvelier A, Gravier FE. Evaluation of the 3-minute chair rise test as part of preoperative evaluation for patients with non-small cell lung cancer. Thorac Cancer 2020; 11:2431-2439. [PMID: 32638551 PMCID: PMC7471043 DOI: 10.1111/1759-7714.13548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 12/25/2022] Open
Abstract
Background Peak oxygen uptake (V˙O2peak) measured by a cardiopulmonary exercise test (CPX) is the gold‐standard for predicting surgical risk in patients with non‐small cell lung cancer (NSCLC). The 3‐minute chair rise test (3CRT) is a simple test requiring minimal resources. This study aimed to determine the ability of 3CRT to predict V˙O2peak in patients with NSCLC. Methods Retrospective data from CPX and 3CRT carried out in 36 patients with NSCLC between March 2018 and February 2019 were included. A multivariate analysis was undertaken to derive a predictive V˙O2peak equation based on performance on the 3CRT. In addition, sensitivity‐specificity analysis was carried out to estimate a threshold 3CRT value for the prediction of V˙O2peak ≥ 15 mL/kg/minute. Results The following equation was obtained: V˙O2peak predicted = (0.04765 × FEV1) ‐ (0.207 59 × BMI) ‐ (0.115 89 × age) + (0.386 09 × vertical distance) + 16.628 69; r2 = 0.75, P < 0.01. The bias between the V˙O2peak values predicted and measured during CPX was 0.0 ± 1.7 mL/kg/minute (95% limits of agreement [−3.5 to 3.5]). A performance ≥49 chair rises predicted V˙O2peak ≥ 15 mL/kg/minute with a sensitivity of 0.75 and a specificity of 0.81. Conclusions The level of error in the prediction of V˙O2peak from 3CRT performance was too great to recommend that 3CRT should replace CPX as the sole measurement of V˙O2peak. Nevertheless, the 3CRT could help to identify those patients that require CPX prior to lung resection surgery for NSCLC, larger prospective study is needed to confirm this hypothesis. Key points Significant findings of the study Cardiopulmonary exercise tests can stratify the surgical risk. Prediction of the peak oxygen uptake (V˙O2peak) value from the 3CRT yields an unacceptable level of error. However, a performance of 49 chair rises or more during the 3CRT could indicate a V˙O2peak ≥ 15 mL / kg / minute. What this study adds The 3CRT is a useful screening tool to determine the necessity for a comprehensive cardiopulmonary exercise test, whose access is limited in clinical practice. It could also allow early screening of patients requiring specific prehabilitation programs.
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Affiliation(s)
- Mathilde Azzi
- Department of Respiratory and Exercise Physiology, Rouen University Hospital, Rouen, France.,Pulmonary, Thoracic Oncology and Respiratory Intensive Care Department, Rouen University Hospital, Rouen, France
| | - David Debeaumont
- Department of Respiratory and Exercise Physiology, Rouen University Hospital, Rouen, France.,CIC-CRB 1404, Rouen University Hospital, Rouen, France
| | - Tristan Bonnevie
- ADIR Association, Rouen University Hospital, Rouen, France.,Normandy University UNIROUEN, UPRES EA 3830, Haute Normandie Research and Biomedical Innovation, Rouen, France
| | | | - Damiano Cerasuolo
- Department of Biostatistics, Rouen University Hospital, Rouen, France
| | - Fairuz Boujibar
- Normandy University UNIROUEN, INSERM U1096, Haute Normandie Research and Biomedical Innovation, Rouen, France.,Department of Thoracic Surgery, Rouen University Hospital, Rouen, France
| | - Antoine Cuvelier
- Pulmonary, Thoracic Oncology and Respiratory Intensive Care Department, Rouen University Hospital, Rouen, France.,Normandy University UNIROUEN, UPRES EA 3830, Haute Normandie Research and Biomedical Innovation, Rouen, France
| | - Francis-Edouard Gravier
- ADIR Association, Rouen University Hospital, Rouen, France.,Normandy University UNIROUEN, UPRES EA 3830, Haute Normandie Research and Biomedical Innovation, Rouen, France
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15
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Marsman M, van Waes JAR, Grobben RB, Weersink CSA, van Klei WA. Added value of subjective assessed functional capacity before non-cardiac surgery in predicting postoperative myocardial injury. Eur J Prev Cardiol 2020; 28:262-269. [PMID: 33891688 DOI: 10.1177/2047487320906918] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 01/27/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Functional capacity is used as an indicator for cardiac testing before non-cardiac surgery and is often performed subjectively. However, the value of subjectively estimated functional capacity in predicting cardiac complications is under debate. We determined the predictive value of subjectively assessed functional capacity on postoperative cardiac complications and mortality. DESIGN An observational cohort study in patients aged 60 years and over undergoing elective inpatient non-cardiac surgery in a tertiary referral hospital. METHODS Subjective functional capacity was determined by anaesthesiologists. The primary outcome was postoperative myocardial injury. Secondary outcomes were postoperative inhospital myocardial infarction and one year mortality. Logistic regression analysis and area under the receiver operating curves were used to determine the added value of functional capacity. RESULTS A total of 4879 patients was included; 824 (17%) patients had a poor subjective functional capacity. Postoperative myocardial injury occurred in 718 patients (15%). Poor functional capacity was associated with myocardial injury (relative risk (RR) 1.7, 95% confidence interval (CI) 1.5-2.0; P < 0.001), postoperative myocardial infarction (RR 2.9, 95% CI 1.9-4.2; P < 0.001) and one year mortality (RR 1.7, 95% CI 1.4-2.0; P < 0.001). After adjustment for other predictors, functional capacity was still a significant predictor for myocardial injury (odds ratio (OR) 1.3, 95% CI 1.0-1.7; P = 0.023), postoperative myocardial infarction (OR 2.0, 95% CI 1.3-3.0; P = 0.002) and one year mortality (OR 1.4, 95% CI 1.1-1.8; P = 0.003), but had no added value on top of other predictors. CONCLUSIONS Subjectively assessed functional capacity is a predictor of postoperative myocardial injury and death, but had no added value on top of other preoperative predictors.
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Affiliation(s)
- Marije Marsman
- Department of Anesthesiology, Universitair Medisch Centrum Utrecht, The Netherlands
| | - Judith A R van Waes
- Department of Anesthesiology, Universitair Medisch Centrum Utrecht, The Netherlands
| | - Remco B Grobben
- Department of Cardiology, Universitair Medisch Centrum Utrecht, The Netherlands
| | - Corien S A Weersink
- Department of Anesthesiology, Universitair Medisch Centrum Utrecht, The Netherlands
| | - Wilton A van Klei
- Department of Anesthesiology, Universitair Medisch Centrum Utrecht, The Netherlands
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Khan T, Usman Y, Abdo T, Chaudry F, Keddissi JI, Youness HA. Diagnosis and management of peripheral lung nodule. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:348. [PMID: 31516894 DOI: 10.21037/atm.2019.03.59] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A solitary pulmonary nodule (SPN) is a well-defined radiographic opacity up to 3 cm in diameter that is surrounded by unaltered aerated lung. Frequently, it is an incidental finding on chest radiographs and chest CT scans. Determining the probability of malignancy is the first step in the evaluation of SPN. This can be done by looking at specific risk factors and the rate of radiographic progression. Subsequent management is guided by the type of the nodule. Patients with solid nodules and low pretest probability can be followed radiographically; those with high probability, who are good surgical candidates, can be referred for surgical resection. When the pretest probability is in the intermediate range additional testing such as biopsy should be done. Various modalities are now available to obtain tissue diagnosis. These modalities differ in their yield and complication rate. Patients with SPN should be well informed of each approach's risks and benefits and should be able to make an informed decision regarding the different diagnostic and therapeutic modalities.
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Affiliation(s)
- Taha Khan
- Interventional Pulmonary Program, Section of Pulmonary, Critical Care and Sleep Medicine, The Oklahoma City VA Health Care System and The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Yasir Usman
- Interventional Pulmonary Program, Section of Pulmonary, Critical Care and Sleep Medicine, The Oklahoma City VA Health Care System and The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Tony Abdo
- Interventional Pulmonary Program, Section of Pulmonary, Critical Care and Sleep Medicine, The Oklahoma City VA Health Care System and The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Fawad Chaudry
- Interventional Pulmonary Program, Section of Pulmonary, Critical Care and Sleep Medicine, The Oklahoma City VA Health Care System and The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Jean I Keddissi
- Interventional Pulmonary Program, Section of Pulmonary, Critical Care and Sleep Medicine, The Oklahoma City VA Health Care System and The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Houssein A Youness
- Interventional Pulmonary Program, Section of Pulmonary, Critical Care and Sleep Medicine, The Oklahoma City VA Health Care System and The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Desaturation during the stair-climbing test for patients who will undergo pulmonary resection: an indicator of postoperative complications. Gen Thorac Cardiovasc Surg 2019; 68:49-56. [PMID: 31165435 DOI: 10.1007/s11748-019-01153-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 05/27/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE It is widely accepted that exercise tolerance tests are applicable in perioperative risk assessment for patients who undergo pulmonary resection; however, the relevance of desaturation during the test is unclear. The purpose of this study was to investigate whether the occurrence of desaturation during a stair-climbing test can be a predictor of postoperative complications among patients who will undergo pulmonary resection and are considered "normal risk" according to published guidelines. METHODS Desaturation was defined as a depression of more than 4% points on a pulse oximeter during stair climbing. Among 186 consecutive patients who underwent pulmonary resection, 162 patients who could climb to the 6th floor were selected for the study (excluding 21 patients who could not stair-climb and 3 patients who could not climb from the first floor to the sixth floor). The relationship of desaturation with postoperative complication was investigated using parameters of cardio-pulmonary status associated with additional foci of oxygen supply duration, intensive care unit stay duration, and hospital stay duration. RESULTS The occurrence ratio of postoperative complications > grade 3 (Clavien-Dindo classification) was 0.75% (1/133) among patients without desaturation and 17.2% (5/29) in patients with desaturation (difference: p = 0.0002). In addition, DS was an indicator of prolonged oxygen supply duration, intensive care unit stay duration, and hospital stay duration. CONCLUSION The occurrence of desaturation during a stair-climbing test for patients who will undergo pulmonary resection can be a predictor of postoperative complications among patients who are classified as having normal risk.
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18
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Can functional inoperability in lung cancer patients be changed by pulmonary rehabilitation? TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 27:212-218. [PMID: 32082855 DOI: 10.5606/tgkdc.dergisi.2019.16474] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 10/06/2018] [Indexed: 12/18/2022]
Abstract
Background This study aims to investigate the effects of shortterm intense pulmonary rehabilitation on respiratory function in patients with lung cancer who were defined as inoperable due to insufficient pulmonary reserve. Methods A total of 25 patients (24 males, 1 female; mean age 62 years; range, 50 to 72 years) who were histologically diagnosed as non-small cell lung carcinoma, considered functionally inoperable due to high risk of an estimated postoperative complication, and suitable for surgical resection according to tumor stage were included in the study. Patients received chest physiotherapy, self-walking and inspiratory muscle training for two weeks. The forced expiratory volume in one second, forced vital capacity, modified Medical Research Council dyspnea scale, six-minute walking distance, maximal inspiratory and expiratory pressures for respiratory muscle strength measurements, and predicted peak maximal oxygen consumption were examined. Results After pulmonary rehabilitation, there was statistically significant improvement in the six-minute walking distance (53 m, p<0.001), dyspnea perception (p<0.001), maximal inspiratory pressure (12 cm H2O, p<0.001), forced vital capacity (p<0.001), predicted forced expiratory volume in one second (%) (p=0.001), forced expiratory volume in one second (Δ forced expiratory volume in one second= 150 mL, p=0.001; Δ maximum value of forced expiratory volume in one second: 650 mL), and predicted maximal oxygen consumption (p<0.001). At the end of the rehabilitation, 60% of the patients (n=15) reevaluated by the surgeons could be operated. Conclusion Short-term intensive pulmonary rehabilitation improves lung functions and exercise capacity while decreasing dyspnea perception. In our study, thanks to the gains derived from the exercise, approximately more than half of the patients could be operated. Therefore, it may be useful to refer patients to rehabilitation before establishing a decision of inoperability.
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Li P, Lai Y, Zhou K, Che G. [Analysis of Postoperative Complications and Risk Factors of Patients with Lung Cancer through Clavien-Dindo Classification]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2017; 20:264-271. [PMID: 28442016 PMCID: PMC5999680 DOI: 10.3779/j.issn.1009-3419.2017.04.07] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
背景与目的 术后并发症是肺切除术后患者死亡的重要原因。在本研究中,我们应用Clavien-Dindo并发症分级系统对肺癌术后并发症按照严重程度进行分级,并分析术后并发症的发生率,探讨不同分级术后并发症的危险因素。 方法 回顾性分析2013年6月-2014年12月四川大学华西医院胸外科966例行肺叶切除术的肺癌患者,依据术后30 d内是否发生并发症将此966例患者分为并发症组与无并发症组;同时根据Clavien-Dindo分级系统将并发症分为4级,并针对不同分级的并发症进行危险因素分析。 结果 966例患者中,并发症组占15.0%(145/966),发生总数380次;依据Clavien-Dindo分级系统将此380次并发症进行分级,其中Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级及以上分别占6.8%、75.3%、15.0%和2.9%。Logistic回归分析结果显示术前第1秒用力呼气容积(forded expiratory volume in one second, FEV1)、肺一氧化碳弥散量(diffusion capacity for carbon monoxide of the lung single breath, DLco SB)及术前合并慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)是术后并发症的独立危险因素;其中术前FEV1是Ⅰ级、Ⅱ级、Ⅲ级及以上并发症的独立危险因素。 结论 在Clavien-Dindo分级系统下,Ⅱ级并发症在术后30天内最常见;FEV1与术后并发症的发生密切相关,可作为评估术后并发症发生风险的可靠指标之一。
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Affiliation(s)
- Pengfei Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yutian Lai
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Kun Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
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Meert AP, Grigoriu B, Licker M, Van Schil PE, Berghmans T. Intensive care in thoracic oncology. Eur Respir J 2017; 49:49/5/1602189. [DOI: 10.1183/13993003.02189-2016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 02/06/2017] [Indexed: 01/21/2023]
Abstract
The admission of lung cancer patients to intensive care is related to postprocedural/postoperative care and medical complications due to cancer or its treatment, but is also related to acute organ failure not directly related to cancer.Despite careful preoperative risk management and the use of modern surgical and anaesthetic techniques, thoracic surgery remains associated with high morbidity, related to the extent of resection and specific comorbidities. Fast-tracking processes with timely recognition and treatment of complications favourably influence patient outcome. Postoperative preventive and therapeutic management has to be carefully planned in order to reduce postoperative morbidity and mortality.For patients with severe complications, intensive care unit (ICU) mortality rate ranges from 13% to 47%, and hospital mortality ranges from 24% to 65%. Common predictors of in-hospital mortality are severity scores, number of failing organs, general condition, respiratory distress and the need for mechanical ventilation or vasopressors. When considering long-term survival after discharge, cancer-related parameters retain their prognostic value.Thoracic surgeons, anesthesiologists, pneumologists, intensivists and oncologists need to develop close and confident partnerships aimed at implementing evidence-based patient care, securing clinical pathways for patient management while promoting education, research and innovation. The final decision on admitting a patient with lung to the ICU should be taken in close partnership between this medical team and the patient and his or her relatives.
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21
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Novoa NM, Esteban P, Rodriguez M, Gomez MT, Varela G. Functional evaluation before lung resection: searching for a low technology test in a safer environment for the patient: a pilot study†. Eur J Cardiothorac Surg 2017; 51:856-860. [DOI: 10.1093/ejcts/ezw403] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 11/01/2016] [Indexed: 11/13/2022] Open
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Abstract
Locally advanced lung cancer remains a surgical indication in selected patients. This condition often demands larger resections. As a consequence preoperative functional workup is of paramount importance to stratify the risk and choose the most appropriate treatment. We reviewed the current evidence on functional evaluation with a special focus on specific aspects related to locally advanced lung cancer stages (i.e., risk after neoadjuvant treatment, pneumonectomy). Evidence is discussed to provide information that could assist clinicians in their preoperative workup of these challenging patients.
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Murakami J, Ueda K, Hayashi M, Kobayashi T, Kunihiro Y, Hamano K. Size-capacity mismatch in the lung: a novel predictor for complications after lung cancer surgery. J Surg Res 2016; 209:131-138. [PMID: 28032549 DOI: 10.1016/j.jss.2016.08.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 08/04/2016] [Accepted: 08/10/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND The aim of the present study was to make a combined pulmonary functional and anatomical assessment using spirometry and computed tomography (CT) to clarify the best predictor for cardiopulmonary complications after thoracoscopic major lung resection for cancer. METHODS We retrospectively reviewed our prospective database of 304 patients undergoing thoracoscopic major lung resection for cancer. The total lung volume (TLV) was measured preoperatively using deep-inspiratory CT by summing the voxels representing -600 to -1024 Hounsfield units. Forced vital capacity (FVC) was measured by spirometry. FVC/TLV was used to diagnose a lung size-function mismatch. We compared among FVC/TLV, conventional spirometric parameters, and the risk of postoperative cardiopulmonary complications. RESULTS Postoperative cardiopulmonary complications developed in 25 of 304 patients (8.2%). There were no cases of operative mortality. A stepwise logistic regression analysis revealed that a history of smoking and low FVC/TLV were independent risk factors for postoperative cardiopulmonary complications in various preoperative measurements. According to a receiver-operating characteristic analysis, FVC/TLV was the only variable that was statistically useful for predicting complications (area under the receiver-operating characteristic curve > 0.7). CONCLUSIONS Lung size-function mismatch was identified as the best predictor for cardiopulmonary complications after major lung resection for cancer among various spirometry- and CT-derived parameters. The usefulness of this parameter in screening for patients who are at risk of complications should be validated by a multicenter, large-scale study because it can be obtained through routine preoperative work.
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Affiliation(s)
- Junichi Murakami
- Division of Chest Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Kazuhiro Ueda
- Division of Chest Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan.
| | - Masataro Hayashi
- Division of Chest Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Taiga Kobayashi
- Division of Radiology, Department of Radiopathology and Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Yoshie Kunihiro
- Division of Radiology, Department of Radiopathology and Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Kimikazu Hamano
- Division of Chest Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
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Villar Álvarez F, Muguruza Trueba I, Belda Sanchis J, Molins López-Rodó L, Rodríguez Suárez PM, Sánchez de Cos Escuín J, Barreiro E, Borrego Pintado MH, Disdier Vicente C, Flandes Aldeyturriaga J, Gámez García P, Garrido López P, León Atance P, Izquierdo Elena JM, Novoa Valentín NM, Rivas de Andrés JJ, Royo Crespo Í, Salvatierra Velázquez Á, Seijo Maceiras LM, Solano Reina S, Aguiar Bujanda D, Avila Martínez RJ, de Granda Orive JI, de Higes Martinez E, Diaz-Hellín Gude V, Embún Flor R, Freixinet Gilart JL, García Jiménez MD, Hermoso Alarza F, Hernández Sarmiento S, Honguero Martínez AF, Jimenez Ruiz CA, López Sanz I, Mariscal de Alba A, Martínez Vallina P, Menal Muñoz P, Mezquita Pérez L, Olmedo García ME, Rombolá CA, San Miguel Arregui I, de Valle Somiedo Gutiérrez M, Triviño Ramírez AI, Trujillo Reyes JC, Vallejo C, Vaquero Lozano P, Varela Simó G, Zulueta JJ. Executive Summary of the SEPAR Recommendations for the Diagnosis and Treatment of Non-small Cell Lung Cancer. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.arbr.2016.02.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Villar Álvarez F, Muguruza Trueba I, Belda Sanchis J, Molins López-Rodó L, Rodríguez Suárez PM, Sánchez de Cos Escuín J, Barreiro E, Borrego Pintado MH, Disdier Vicente C, Flandes Aldeyturriaga J, Gámez García P, Garrido López P, León Atance P, Izquierdo Elena JM, Novoa Valentín NM, Rivas de Andrés JJ, Royo Crespo Í, Salvatierra Velázquez Á, Seijo Maceiras LM, Solano Reina S, Aguiar Bujanda D, Avila Martínez RJ, de Granda Orive JI, de Higes Martinez E, Diaz-Hellín Gude V, Embún Flor R, Freixinet Gilart JL, García Jiménez MD, Hermoso Alarza F, Hernández Sarmiento S, Honguero Martínez AF, Jimenez Ruiz CA, López Sanz I, Mariscal de Alba A, Martínez Vallina P, Menal Muñoz P, Mezquita Pérez L, Olmedo García ME, Rombolá CA, San Miguel Arregui I, de Valle Somiedo Gutiérrez M, Triviño Ramírez AI, Trujillo Reyes JC, Vallejo C, Vaquero Lozano P, Varela Simó G, Zulueta JJ. Executive summary of the SEPAR recommendations for the diagnosis and treatment of non-small cell lung cancer. Arch Bronconeumol 2016; 52:378-88. [PMID: 27237592 DOI: 10.1016/j.arbres.2016.02.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 02/22/2016] [Accepted: 02/24/2016] [Indexed: 02/07/2023]
Abstract
The Thoracic Surgery and Thoracic Oncology groups of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) have backed the publication of a handbook on recommendations for the diagnosis and treatment of non-small cell lung cancer. Due to the high incidence and mortality of this disease, the best scientific evidence must be constantly updated and made available for consultation by healthcare professionals. To draw up these recommendations, we called on a wide-ranging group of experts from the different specialties, who have prepared a comprehensive review, divided into 4 main sections. The first addresses disease prevention and screening, including risk factors, the role of smoking cessation, and screening programs for early diagnosis. The second section analyzes clinical presentation, imaging studies, and surgical risk, including cardiological risk and the evaluation of respiratory function. The third section addresses cytohistological confirmation and staging studies, and scrutinizes the TNM and histological classifications, non-invasive and minimally invasive sampling methods, and surgical techniques for diagnosis and staging. The fourth and final section looks at different therapeutic aspects, such as the role of surgery, chemotherapy, radiation therapy, a multidisciplinary approach according to disease stage, and other specifically targeted treatments, concluding with recommendations on the follow-up of lung cancer patients and surgical and endoscopic palliative interventions in advanced stages.
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Affiliation(s)
| | | | - José Belda Sanchis
- Servicio de Cirugía Torácica, Hospital Universitari Mútua Terrassa, España
| | | | | | | | - Esther Barreiro
- Grupo de Investigación en Desgaste Muscular y Caquexia en Enfermedades Crónicas Respiratorias y Cáncer de Pulmón, Instituto de Investigación del Hospital del Mar (IMIM)-Hospital del Mar, Departamento de Ciencias Experimentales y de la Salud (CEXS), Universidad Pompeu Fabra, Parc de Recerca Biomèdica de Barcelona (PRBB); Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Barcelona. España
| | | | | | - Javier Flandes Aldeyturriaga
- Unidad de Broncoscopias y Neumología Intervencionista, Servicio de Neumología, ISS Fundación Jiménez Díaz, UAM, CIBERES, Madrid, España
| | - Pablo Gámez García
- Servicio de Cirugía Torácica, Hospital Universitario 12 de Octubre, Madrid, España
| | - Pilar Garrido López
- Servicio de Oncología Médica, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Pablo León Atance
- Servicio de Cirugía Torácica, Complejo Hospitalario Universitario de Albacete, España
| | | | | | - Juan José Rivas de Andrés
- Hospital Universitario Miguel Servet, Hospital Clínico Universitario Lozano Blesa e IIS Aragón, Zaragoza, España
| | - Íñigo Royo Crespo
- Hospital Universitario Miguel Servet, Hospital Clínico Universitario Lozano Blesa e IIS Aragón, Zaragoza, España
| | | | | | | | - David Aguiar Bujanda
- Servicio de Oncología Médica, Hospital Universitario de Gran Canaria «Dr. Negrín», España
| | | | | | | | | | - Raúl Embún Flor
- Hospital Universitario Miguel Servet, Hospital Clínico Universitario Lozano Blesa e IIS Aragón, Zaragoza, España
| | | | | | | | | | | | | | - Iker López Sanz
- Servicio de Cirugía Torácica, Hospital Universitario Donostia, España
| | | | - Primitivo Martínez Vallina
- Hospital Universitario Miguel Servet, Hospital Clínico Universitario Lozano Blesa e IIS Aragón, Zaragoza, España
| | - Patricia Menal Muñoz
- Servicio de Radiología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - Laura Mezquita Pérez
- Servicio de Oncología Médica, Hospital Universitario Ramón y Cajal, Madrid, España
| | | | - Carlos A Rombolá
- Servicio de Cirugía Torácica, Complejo Hospitalario Universitario de Albacete, España
| | - Iñigo San Miguel Arregui
- Servicio de Oncología Radioterápica, Hospital Universitario de Gran Canaria «Dr. Negrín», España
| | - María de Valle Somiedo Gutiérrez
- Unidad de Broncoscopias y Neumología Intervencionista, Servicio de Neumología, ISS Fundación Jiménez Díaz, UAM, CIBERES, Madrid, España
| | | | | | - Carmen Vallejo
- Servicio de Oncología Radioterápica, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Paz Vaquero Lozano
- Unidad de Tabaquismo, Servicio de Neumología H.G.U. Gregorio Marañón, Madrid, España
| | - Gonzalo Varela Simó
- Servicio de Cirugía Torácica, Complejo Asistencial Universitario de Salamanca, España
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Santos BFA, Souza HCD, Miranda APB, Cipriano FG, Gastaldi AC. Performance in the 6-minute walk test and postoperative pulmonary complications in pulmonary surgery: an observational study. Braz J Phys Ther 2016; 20:66-72. [PMID: 26786074 PMCID: PMC4835166 DOI: 10.1590/bjpt-rbf.2014.0119] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 07/24/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES: To assess functional capacity in the preoperative phase of pulmonary surgery by
comparing predicted and obtained values for the six-minute walk test (6MWT) in
patients with and without postoperative pulmonary complication (PPC) METHOD: Twenty-one patients in the preoperative phase of open thoracotomy were evaluated
using the 6MWT, followed by monitoring of the postoperative evolution of each
participant who underwent the routine treatment. Participants were then divided
into two groups: the group with PPC and the group without PPC. The results were
also compared with the predicted values using reference equations for the 6MWT RESULTS: Over half (57.14%) of patients developed PPC. The 6MWT was associated with the
odds for PPC (odds ratio=22, p=0.01); the group without PPC in the postoperative
period walked 422.38 (SD=72.18) meters during the 6MWT, while the group with PPC
walked an average of 340.89 (SD=100.93) meters (p=0.02). The distance traveled by
the group without PPC was 80% of the predicted value, whereas the group with PPC
averaged less than 70% (p=0.03), with more appropriate predicted values for the
reference equations CONCLUSIONS: The 6MWT is an easy, safe, and feasible test for routine preoperative evaluation
in pulmonary surgery and may indicate patients with a higher chance of developing
PPC.
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Affiliation(s)
- Bruna F A Santos
- Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Hugo C D Souza
- Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Aline P B Miranda
- Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Faculdade de Medicina de Ribeirão Preto, USP, Ribeirão Preto, SP, Brazil
| | - Federico G Cipriano
- Departamento de Clínica Cirúrgica, Faculdade de Medicina de Ribeirão Preto, USP, Ribeirão Preto, SP, Brazil
| | - Ada C Gastaldi
- Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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Bernasconi M, Diacon AH, Koegelenberg CFN. Stair Climbing Test Streamlines the Evaluation of Nonmalignant Lung Resection Candidates. Respiration 2015; 91:87-8. [PMID: 26674645 DOI: 10.1159/000442889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Maurizio Bernasconi
- Division of Pulmonology, Department of Medicine, University Hospital of Lausanne, Lausanne, Switzerland
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Ha D, Fuster M, Ries AL, Wagner PD, Mazzone PJ. Heart Rate Recovery as a Preoperative Test of Perioperative Complication Risk. Ann Thorac Surg 2015; 100:1954-62. [PMID: 26410158 DOI: 10.1016/j.athoracsur.2015.06.085] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 06/09/2015] [Accepted: 06/22/2015] [Indexed: 12/25/2022]
Abstract
The autonomic nervous system plays important physiologic roles in a variety of organ systems. Autonomic dysfunction has been shown to be predictive of increased mortality in patients with cardiovascular disease. Its importance in patients with chronic respiratory disorders has been described in recent years. Here, we summarize the prognostic value of autonomic dysfunction, as reflected by impaired heart rate recovery (HRR), in patients with chronic respiratory disorders, including chronic obstructive pulmonary disease, interstitial lung disease, and lung cancer. We suggest that HRR may be clinically useful in the preoperative physiologic evaluation, specifically in lung cancer patients being considered for surgery.
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Affiliation(s)
- Duc Ha
- Pulmonary and Critical Care Medicine Division, University of California, San Diego, La Jolla, California.
| | - Mark Fuster
- VA San Diego Healthcare System, San Diego, California; Pulmonary and Critical Care Medicine Division, University of California, San Diego, La Jolla, California
| | - Andrew L Ries
- Pulmonary and Critical Care Medicine Division, University of California, San Diego, La Jolla, California
| | - Peter D Wagner
- Pulmonary and Critical Care Medicine Division, University of California, San Diego, La Jolla, California
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Pulmonary function tests in the preoperative evaluation of lung cancer surgery candidates. A review of guidelines. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2015; 11:278-82. [PMID: 26336435 PMCID: PMC4283874 DOI: 10.5114/kitp.2014.45677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 01/17/2014] [Accepted: 06/23/2014] [Indexed: 11/17/2022]
Abstract
Before planned surgical treatment of lung cancer, the patient's respiratory system function should be evaluated. According to the current guidelines, the assessment should start with measurements of FEV1 (forced expiratory volume in 1 second) and DLco (carbon monoxide lung diffusion capacity). Pneumonectomy is possible when FEV1 and DLco are > 80% of the predicted value (p.v.). If either of these parameters is < 80%, an exercise test with VO2 max (oxygen consumption during maximal exercise) measurement should be performed. When VO2 max is < 35 % p.v. or < 10 ml/kg/min, resection is associated with high risk. If VO2 max is in the range of 35-75% p.v. or 10-20 ml/kg/min, the postoperative values of FEV1 and DLco (ppoFEV1, ppoDLco) should be determined. The exercise test with VO2 max measurement may be replaced with other tests such as the shuttle walk test and the stair climbing test. The distance covered during the shuttle walk test should be > 400 m. Patients considered for lobectomy should be able to climb 3 flights of stairs (12 m) and for pneumonectomy 5 flights of stairs (22 m).
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Lee AL, Harrison SL, Beauchamp MK, Janaudis-Ferreira T, Brooks D. Alternative field exercise tests for people with respiratory conditions. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2015. [DOI: 10.1007/s40141-015-0097-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Celli BR, Decramer M, Wedzicha JA, Wilson KC, Agustí A, Criner GJ, MacNee W, Make BJ, Rennard SI, Stockley RA, Vogelmeier C, Anzueto A, Au DH, Barnes PJ, Burgel PR, Calverley PM, Casanova C, Clini EM, Cooper CB, Coxson HO, Dusser DJ, Fabbri LM, Fahy B, Ferguson GT, Fisher A, Fletcher MJ, Hayot M, Hurst JR, Jones PW, Mahler DA, Maltais F, Mannino DM, Martinez FJ, Miravitlles M, Meek PM, Papi A, Rabe KF, Roche N, Sciurba FC, Sethi S, Siafakas N, Sin DD, Soriano JB, Stoller JK, Tashkin DP, Troosters T, Verleden GM, Verschakelen J, Vestbo J, Walsh JW, Washko GR, Wise RA, Wouters EFM, ZuWallack RL. An Official American Thoracic Society/European Respiratory Society Statement: Research questions in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2015; 191:e4-e27. [PMID: 25830527 DOI: 10.1164/rccm.201501-0044st] [Citation(s) in RCA: 141] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity, mortality, and resource use worldwide. The goal of this Official American Thoracic Society (ATS)/European Respiratory Society (ERS) Research Statement is to describe evidence related to diagnosis, assessment, and management; identify gaps in knowledge; and make recommendations for future research. It is not intended to provide clinical practice recommendations on COPD diagnosis and management. METHODS Clinicians, researchers, and patient advocates with expertise in COPD were invited to participate. A literature search of Medline was performed, and studies deemed relevant were selected. The search was not a systematic review of the evidence. Existing evidence was appraised and summarized, and then salient knowledge gaps were identified. RESULTS Recommendations for research that addresses important gaps in the evidence in all areas of COPD were formulated via discussion and consensus. CONCLUSIONS Great strides have been made in the diagnosis, assessment, and management of COPD as well as understanding its pathogenesis. Despite this, many important questions remain unanswered. This ATS/ERS Research Statement highlights the types of research that leading clinicians, researchers, and patient advocates believe will have the greatest impact on patient-centered outcomes.
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32
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La prueba de escaleras. En búsqueda de la necesaria simplicidad. Arch Bronconeumol 2015; 51:259-60. [DOI: 10.1016/j.arbres.2015.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 02/06/2015] [Accepted: 02/06/2015] [Indexed: 11/23/2022]
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Kim I, Lee H. [Effects of a progressive walking program on physical activity, exercise tolerance, recovery, and post-operative complications in patients with a lung resection]. J Korean Acad Nurs 2015; 44:381-90. [PMID: 25231803 DOI: 10.4040/jkan.2014.44.4.381] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE The purpose of this study was to identify the effects of a Progressive Walking program (PW) on physical activity, exercise tolerance, recovery, and post-operative complications for patients with a lung resection. METHODS A nonequivalent control group non-synchronized design was utilized and 37 participants with a lung resection (22 for control group, 15 for experimental group) were recruited at A university hospital from December 2012 to August 2013. The PW consisted of preoperative education, goal setting, and feedback, provided to the experimental group, and usual care to the control group. Data were analyzed using the SPSS WIN 18.0. RESULTS A higher proportion of patients in the experimental group showed adequate levels of physical activity (p=.001), shorter period of chest tube retention (≤ 7 days; p=.011), and shorter stay in the hospital (≤ 10 days; p=.036) than patients in the control group. Patients in the experimental group reported longer 6-minute walking distance (p=.032) and lower levels of dyspnea (p=.049) than patients in the control group. The PW did not influence the occurrence of pulmonary complications. CONCLUSION The findings of this study suggest that the PW could be a useful strategy for improving patients' post-operative health and reducing cost after lung resection.
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Affiliation(s)
- Inah Kim
- College of Nursing, Pusan National University, Yangsan, Korea
| | - Haejung Lee
- College of Nursing, Pusan National University, Yangsan, Korea.
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Celli BR, Decramer M, Wedzicha JA, Wilson KC, Agustí A, Criner GJ, MacNee W, Make BJ, Rennard SI, Stockley RA, Vogelmeier C, Anzueto A, Au DH, Barnes PJ, Burgel PR, Calverley PM, Casanova C, Clini EM, Cooper CB, Coxson HO, Dusser DJ, Fabbri LM, Fahy B, Ferguson GT, Fisher A, Fletcher MJ, Hayot M, Hurst JR, Jones PW, Mahler DA, Maltais F, Mannino DM, Martinez FJ, Miravitlles M, Meek PM, Papi A, Rabe KF, Roche N, Sciurba FC, Sethi S, Siafakas N, Sin DD, Soriano JB, Stoller JK, Tashkin DP, Troosters T, Verleden GM, Verschakelen J, Vestbo J, Walsh JW, Washko GR, Wise RA, Wouters EF, ZuWallack RL. An official American Thoracic Society/European Respiratory Society statement: research questions in COPD. Eur Respir J 2015; 45:879-905. [DOI: 10.1183/09031936.00009015] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity, mortality, and resource use worldwide. The goal of this official American Thoracic Society (ATS)/European Respiratory Society (ERS) research statement is to describe evidence related to diagnosis, assessment and management; identify gaps in knowledge; and make recommendations for future research. It is not intended to provide clinical practice recommendations on COPD diagnosis and management.Clinicians, researchers, and patient advocates with expertise in COPD were invited to participate. A literature search of Medline was performed, and studies deemed relevant were selected. The search was not a systematic review of the evidence. Existing evidence was appraised and summarised, and then salient knowledge gaps were identified.Recommendations for research that addresses important gaps in the evidence in all areas of COPD were formulatedviadiscussion and consensus.Great strides have been made in the diagnosis, assessment and management of COPD, as well as understanding its pathogenesis. Despite this, many important questions remain unanswered. This ATS/ERS research statement highlights the types of research that leading clinicians, researchers, and patient advocates believe will have the greatest impact on patient-centred outcomes.
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35
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Stanzani F, Paisani DDM, Oliveira AD, Souza RCD, Perfeito JAJ, Faresin SM. Morbidity, mortality, and categorization of the risk of perioperative complications in lung cancer patients. ACTA ACUST UNITED AC 2014; 40:21-9. [PMID: 24626266 PMCID: PMC4075917 DOI: 10.1590/s1806-37132014000100004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 10/28/2013] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To determine morbidity and mortality rates by risk category in accordance with the American College of Chest Physicians guidelines, to determine what role pulmonary function tests play in this categorization process, and to identify risk factors for perioperative complications (PCs). METHODS This was a historical cohort study based on preoperative and postoperative data collected for cases of lung cancer diagnosed or suspected between 2001 and 2010. RESULTS Of the 239 patients evaluated, only 13 (5.4%) were classified as being at high risk of PCs. Predicted postoperative FEV1 (FEV1ppo) was sufficient to define the risk level in 156 patients (65.3%); however, cardiopulmonary exercise testing (CPET) was necessary for identifying those at high risk. Lung resection was performed in 145 patients. Overall morbidity and mortality rates were similar to those reported in other studies. However, morbidity and mortality rates for patients at an acceptable risk of PCs were 31.6% and 4.3%, respectively, whereas those for patients at high risk were 83.3% and 33.3%. Advanced age, COPD, lobe resection, and lower FEV1ppo were correlated with PCs. CONCLUSIONS Although spirometry was sufficient for risk assessment in the majority of the population studied, CPET played a key role in the identification of high-risk patients, among whom the mortality rate was seven times higher than was that observed for those at an acceptable risk of PCs. The risk factors related to PCs coincided with those reported in previous studies.
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Affiliation(s)
- Fabiana Stanzani
- Federal University of São Paulo, Department of Medicine, São Paulo, Brazil, Physician. Pulmonology Section, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Denise de Moraes Paisani
- Arnaldo Vieira de Carvalho Cancer Institute, São Paulo, Brazil, Thoracic Surgeon. Arnaldo Vieira de Carvalho Cancer Institute, São Paulo, Brazil
| | - Anderson de Oliveira
- Federal University of São Paulo, Department of Medicine, São Paulo, Brazil, Thoracic Surgeon. Thoracic Surgeon Section, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Rodrigo Caetano de Souza
- Federal University of São Paulo, Department of Medicine, São Paulo, Brazil, Thoracic Surgeon. Thoracic Surgeon Section, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - João Aléssio Juliano Perfeito
- Federal University of São Paulo, Department of Medicine, São Paulo, Brazil, Affiliate Professor. Pulmonology Section, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
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Spyratos D, Zarogoulidis P, Porpodis K, Angelis N, Papaiwannou A, Kioumis I, Pitsiou G, Pataka A, Tsakiridis K, Mpakas A, Arikas S, Katsikogiannis N, Kougioumtzi I, Tsiouda T, Machairiotis N, Siminelakis S, Argyriou M, Kotsakou M, Kessis G, Kolettas A, Beleveslis T, Zarogoulidis K. Preoperative evaluation for lung cancer resection. J Thorac Dis 2014; 6 Suppl 1:S162-6. [PMID: 24672690 DOI: 10.3978/j.issn.2072-1439.2014.03.06] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 03/07/2014] [Indexed: 12/25/2022]
Abstract
During the last decades lung cancer is the leading cause of death worldwide for both sexes. Even though cigarette smoking has been proved to be the main causative factor, many other agents (e.g., occupational exposure to asbestos or heavy metals, indoor exposure to radon gas radiation, particulate air pollution) have been associated with its development. Recently screening programs proved to reduce mortality among heavy-smokers although establishment of such strategies in everyday clinical practice is much more difficult and unknown if it is cost effective compared to other neoplasms (e.g., breast or prostate cancer). Adding severe comorbidities (coronary heart disease, COPD) to the above reasons as cigarette smoking is a common causative factor, we could explain the low surgical resection rates (approximately 20-30%) for lung cancer patients. Three clinical guidelines reports of different associations have been published (American College of Chest Physisians, British Thoracic Society and European Respiratory Society/European Society of Thoracic Surgery) providing detailed algorithms for preoperative assessment. In the current mini review, we will comment on the preoperative evaluation of lung cancer patients.
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Affiliation(s)
- Dionysios Spyratos
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 5 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 6 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 7 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 8 Oncology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 9 Anesthisiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Paul Zarogoulidis
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 5 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 6 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 7 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 8 Oncology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 9 Anesthisiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Konstantinos Porpodis
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 5 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 6 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 7 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 8 Oncology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 9 Anesthisiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Nikolaos Angelis
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 5 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 6 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 7 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 8 Oncology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 9 Anesthisiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Antonios Papaiwannou
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 5 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 6 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 7 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 8 Oncology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 9 Anesthisiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Ioannis Kioumis
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 5 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 6 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 7 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 8 Oncology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 9 Anesthisiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Georgia Pitsiou
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 5 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 6 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 7 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 8 Oncology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 9 Anesthisiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Athanasia Pataka
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 5 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 6 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 7 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 8 Oncology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 9 Anesthisiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Kosmas Tsakiridis
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 5 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 6 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 7 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 8 Oncology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 9 Anesthisiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Andreas Mpakas
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 5 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 6 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 7 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 8 Oncology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 9 Anesthisiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Stamatis Arikas
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 5 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 6 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 7 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 8 Oncology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 9 Anesthisiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Nikolaos Katsikogiannis
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 5 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 6 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 7 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 8 Oncology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 9 Anesthisiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Ioanna Kougioumtzi
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 5 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 6 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 7 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 8 Oncology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 9 Anesthisiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Theodora Tsiouda
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 5 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 6 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 7 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 8 Oncology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 9 Anesthisiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Nikolaos Machairiotis
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 5 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 6 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 7 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 8 Oncology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 9 Anesthisiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Stavros Siminelakis
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 5 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 6 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 7 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 8 Oncology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 9 Anesthisiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Michael Argyriou
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 5 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 6 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 7 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 8 Oncology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 9 Anesthisiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Maria Kotsakou
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 5 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 6 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 7 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 8 Oncology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 9 Anesthisiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - George Kessis
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 5 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 6 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 7 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 8 Oncology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 9 Anesthisiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Alexander Kolettas
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 5 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 6 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 7 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 8 Oncology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 9 Anesthisiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Thomas Beleveslis
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 5 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 6 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 7 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 8 Oncology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 9 Anesthisiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Konstantinos Zarogoulidis
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 5 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 6 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 7 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 8 Oncology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 9 Anesthisiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
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Abstract
Lung cancer patients with medical comorbidity are a challenge for care providers. As with other solid tumors, treatment is stage dependent; but a critical difference is the invasive nature of lung resections and the resulting importance of surgical risk stratification for treatment of early stage disease. External beam radiation was considered the only treatment option for early stage disease in non-operative candidates 10-15 years ago. With recent advances in image-guided technologies, robotics, and the resurgence in interest of sublobar resection there are now numerous treatment options which offer excellent local control and reasonable short and long term survival. Extensive work has been done to clarify interventional risk, and accurately describe anticipated outcomes of these varied treatments in the high risk population. The aim of this article is to review recent literature and provide a better understanding of the considerations used in the management of these patients in the current era.
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Affiliation(s)
- Joanna Sesti
- Department of Cardiothoracic Surgery, NYU School of Medicine, 530 1st Ave, Suite 9V, New York, NY, USA
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Rodriguez-Larrad A, Lascurain-Aguirrebena I, Abecia-Inchaurregui LC, Seco J. Perioperative physiotherapy in patients undergoing lung cancer resection. Interact Cardiovasc Thorac Surg 2014; 19:269-81. [DOI: 10.1093/icvts/ivu126] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Mazzone PJ. Preoperative evaluation of the lung cancer resection candidate. Expert Rev Respir Med 2014; 4:97-113. [DOI: 10.1586/ers.09.68] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Vargas Fajardo MDC, Novoa Valentín NM, Jiménez López MF, Ramos Gonzalez J, Varela Simó G. An alternative method for predicting the risk of postoperative complications in lung resection. Arch Bronconeumol 2013; 50:87-92. [PMID: 24332799 DOI: 10.1016/j.arbres.2013.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 08/18/2013] [Accepted: 09/12/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The aims of this study were to design a best fit linear regression model to estimate VO2max (estimated VO2) and to compare the ability of VO2 values (measured and estimated) predicting cardiorespiratory complications in a series of patients undergoing lung resection for lung cancer. METHOD This was a prospective, observational study performed in 83 patients. Variables analyzed were: demographic characteristics, comorbidity, body mass index (BMI), FEV1%, FVC%, diffusion capacity (DLCO%), mean daily distance walked in kilometers, VO2max measured by cardio-pulmonary exercise test (CPET) and postoperative complications. Descriptive and comparative statistical analysis of the variables was performed using the Mann-Whitney test for categorical variables and the Student's t-test for continuous variables. A new linear regression model was designed, where the dependent variable (measured VO2max) was estimated by the distance, DLCO% and age, resulting in the estimated VO2. The predictive power of the measured and estimated consumption was analyzed using the Student's t-test, grouping by the occurrence or absence of cardiorespiratory complications. RESULTS Both groups were homogeneous for age, sex, BMI, FEV1%, DLCO%, comorbidity, type of resection performed and mean distance walked per day. Estimated VO2 and measured VO2 were normally distributed (K-Smirnov test, P>.32). VO2 means estimated by the model (age, DLCO% and mean distance walked per day) were significantly different between patients with and without complications (Student's t test, P=.037) compared with measured VO2 values, which did not differentiate groups (Student's t test, P=.42). CONCLUSION The VO2max estimated by the model is more predictive in this case series than the VO2max measured during a standard exercise test.
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Affiliation(s)
| | | | | | - Jacinto Ramos Gonzalez
- Servicio de Neumología, Unidad de Pruebas Funcionales Respiratorias, Hospital Universitario de Salamanca, Salamanca, España
| | - Gonzalo Varela Simó
- Servicio de Cirugía Torácica, Hospital Universitario de Salamanca, IBSAL, Salamanca, España
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Refai M, Pompili C, Salati M, Xiume F, Sabbatini A, Brunelli A. Can maximal inspiratory and expiratory pressures during exercise predict complications in patients submitted to major lung resections? A prospective cohort study. Eur J Cardiothorac Surg 2013; 45:665-69; discussion 669-70. [DOI: 10.1093/ejcts/ezt440] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Stefanelli F, Meoli I, Cobuccio R, Curcio C, Amore D, Casazza D, Tracey M, Rocco G. High-intensity training and cardiopulmonary exercise testing in patients with chronic obstructive pulmonary disease and non-small-cell lung cancer undergoing lobectomy. Eur J Cardiothorac Surg 2013; 44:e260-5. [PMID: 23892298 DOI: 10.1093/ejcts/ezt375] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Peak VO2, as measure of physical performance is central to a correct preoperative evaluation in patients with both non-small-cell lung cancer (NSCLC) and chronic obstructive pulmonary disease (COPD) because it is closely related both to operability criteria and the rate of postoperative complications. Strategies to improve peak VO2, as a preoperative pulmonary rehabilitation programme (PRP), should be considered favourably in these patients. In order to clarify the role of pulmonary rehabilitation, we have evaluated the effects of 3-week preoperative high-intensity training on physical performance and respiratory function in a group of patients with both NSCLC and COPD who underwent lobectomy. METHODS We studied 40 patients with both NSCLC and COPD, age < 75 years, TNM stages I-II, who underwent lobectomy. Patients were randomly divided into two groups (R and S): Group R underwent an intensive preoperative PRP, while Group S underwent only lobectomy. We evaluated peak VO2 in all patients at Time 0 (T0), after PRP/before surgery in Group R/S (T1) and 60 days after surgery, respectively, in both groups (T2). RESULTS There was no difference between groups in peak VO2 at T0, while a significant difference was observed both at T1 and T2. In Group R, peak VO2 improves significantly from T0 to T1: 14.9 ± 2.3-17.8 ± 2.1 ml/kg/min ± standard deviation (SD), P < 0.001 (64.5 ± 16.5-76.1 ± 14.9% predicted ± SD, P < 0.05) and deteriorates from T1 to T2: 17.8 ± 2.1-15.1 ± 2.4, P < 0.001 (76.1 ± 14.9-64.6 ± 15.5, P < 0.05), reverting to a similar value to that at T0, while in Group S peak VO2 did not change from T0 to T1 and significantly deteriorates from T1 to T2: 14.5 ± 1.2-11.4 ± 1.2 ml/kg/min ± SD, P < 0.00001 (60.6 ± 8.4-47.4 ± 6.9% predicted ± SD, P < 0.00001). CONCLUSIONS PRP was a valid preoperative strategy to improve physical performance in patients with both NSCLC and COPD and this advantage was also maintained after surgery.
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Arruda KA, Cataneo DC, Cataneo AJM. Surgical risk tests related to cardiopulmonary postoperative complications: comparison between upper abdominal and thoracic surgery. Acta Cir Bras 2013; 28:458-66. [DOI: 10.1590/s0102-86502013000600010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 05/10/2013] [Indexed: 11/22/2022] Open
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Brunelli A, Kim AW, Berger KI, Addrizzo-Harris DJ. Physiologic Evaluation of the Patient With Lung Cancer Being Considered for Resectional Surgery. Chest 2013; 143:e166S-e190S. [DOI: 10.1378/chest.12-2395] [Citation(s) in RCA: 542] [Impact Index Per Article: 49.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Ambrozin ARP, Cataneo DC, Arruda KA, Cataneo AJM. Time in the stair-climbing test as a predictor of thoracotomy postoperative complications. J Thorac Cardiovasc Surg 2013; 145:1093-1097. [DOI: 10.1016/j.jtcvs.2012.09.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 08/03/2012] [Accepted: 09/04/2012] [Indexed: 11/24/2022]
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Functional capacity, physical activity and muscle strength assessment of individuals with non-small cell lung cancer: a systematic review of instruments and their measurement properties. BMC Cancer 2013; 13:135. [PMID: 23514337 PMCID: PMC3623892 DOI: 10.1186/1471-2407-13-135] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 03/07/2013] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The measurement properties of instruments used to assess functional capacity, physical activity and muscle strength in participants with non-small cell lung cancer (NSCLC) have not been systematically reviewed. METHOD OBJECTIVES To identify outcome measures used to assess these outcomes in participants with NSCLC; and to evaluate, synthesise and compare the measurement properties of the outcome measures identified. DATA SOURCES A systematic review of articles using electronic databases MEDLINE (1950-2012), CINAHL (1982-2012), EMBASE (1980-2012), Cochrane Library (2012), Expanded Academic ASAP (1994-2012), Health Collection Informit (1995-2012) and PEDRO (1999-2012). Additional studies were identified by searching personal files and cross referencing. Eligibility Criteria for Study Selection: Search one: studies which assessed functional capacity, physical activity or muscle strength in participants with NSCLC using non-laboratory objective tests were included. Search two: studies which evaluated a measurement property (inter- or intra-rater reliability; measurement error; criterion or construct validity; or responsiveness) in NSCLC for one of the outcome measures identified in search one. Studies published in English from 1980 were eligible. Data Extraction and Methodological Quality Assessment: data collection form was developed and data extracted. Methodological quality of studies was assessed by two independent reviewers using the 4-point COSMIN checklist. RESULTS Thirteen outcome measures were identified. Thirty-one studies evaluating measurement properties of the outcome measures in participants with NSCLC were included. Functional capacity was assessed using the six- and twelve-minute walk tests; incremental- and endurance-shuttle walk tests; and the stair-climbing test. Criterion validity for three of these measures was established in NSCLC but not the reliability or responsiveness. Physical activity was measured using accelerometers and pedometers. Only the construct validity for accelerometers and pedometers was reported. Muscle strength was measured using hand-held dynamometry, hand-grip dynamometry, manual muscle test, one-repetition maximum and the chair-stand test, however only two studies reported reliability and measurement error and one study reported construct validity. CONCLUSION Currently there is a gap in the literature regarding the measurement properties of commonly used outcome measures in NSCLC participants, particularly reliability, measurement error and responsiveness. Further research needs to be conducted to determine the most suitable outcome measures for use in trials involving NSCLC participants.
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Shiono S, Abiko M, Sato T. Postoperative complications in elderly patients after lung cancer surgery. Interact Cardiovasc Thorac Surg 2013; 16:819-23. [PMID: 23427311 DOI: 10.1093/icvts/ivt034] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The purpose of this study was to identify the risk factors for postoperative complications in elderly patients undergoing lung cancer surgery. These complications remain higher in elderly patients than in young patients, and decreasing their incidence is an important goal. We investigated surgical factors in particular, including surgical time, blood loss and thoracotomy length. METHODS Between January 2000 and September 2009, 567 patients underwent lung cancer surgery at our institution. We retrospectively reviewed the records of 119 patients who underwent lobectomy, aged 75 years or older, for possible postoperative complication risk factors. RESULTS The patients' median age was 77 years (range, 75-88 years); there were 79 men and 40 women. There were no perioperative or postoperative deaths. Postoperative complications developed in 41 (34.5%) patients, including 17 (14.3%) with arrhythmia, 10 (8.4%) with prolonged air leak, 10 (8.4%) with delirium, 8 (6.7%) with pneumonia, 4 (3.4%) with hypoxia, 2 (1.7%) with cerebrovascular disease and 1 (0.8%) with postoperative haemorrhage. Univariate analysis showed that the risk factors for postoperative complications consisted of longer surgery time (P = 0.002), blood loss (P = 0.021) and undergoing surgery prior to May 2004 (P = 0.002). Multivariate analysis revealed that surgery time (P = 0.041) and surgery prior to May 2004 (P = 0.008) were independent risk factors for postoperative complications. CONCLUSIONS This study demonstrates that the quality of surgery is an important factor in determining the risk of postoperative complications. Severe adhesions and lung inflammation are conditions that make lung cancer surgery difficult; a skillful and meticulous surgical technique is required in elderly patients.
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Affiliation(s)
- Satoshi Shiono
- Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan.
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Paisani DM, Fiore JF, Lunardi AC, Colluci DBB, Santoro IL, Carvalho CRF, Chiavegato LD, Faresin SM. Preoperative 6-min walking distance does not predict pulmonary complications in upper abdominal surgery. Respirology 2013; 17:1013-7. [PMID: 22616954 DOI: 10.1111/j.1440-1843.2012.02202.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Field exercise tests have been increasingly used for pulmonary risk assessment. The 6-min walking distance (6MWD) is a field test commonly employed in clinical practice; however, there is limited evidence supporting its use as a risk assessment method in abdominal surgery. The aim was to assess if the 6MWD can predict the development of post-operative pulmonary complications (PPCs) in patients having upper abdominal surgery (UAS). METHODS This prospective cohort study included 137 consecutive subjects undergoing elective UAS. Subjects performed the 6MWD on the day prior to surgery, and their performance were compared with predicted values of 6MWD (p6MWD) using a previously validated formula. PPCs (including pneumonia, tracheobronchitis, atelectasis with clinical repercussions, bronchospasm and acute respiratory failure) were assessed daily by a pulmonologist blinded to the 6MWD results. 6MWD and p6MWD were compared between subjects who developed PPC (PPC group) and those who did not (no PPC group) using Student's t-test. RESULTS Ten subjects experienced PPC (7.2%) and no significant difference was observed between the 6MWD obtained in the PPC group and no PPC group (466.0 ± 97.0 m vs. 485.3 ± 107.1 m; P = 0.57, respectively). There was also no significant difference observed between groups for the p6MWD (100.7 ± 29.1% vs. 90.6 ± 20.9%; P > 0.05). CONCLUSIONS The results of the present study suggest that the 6-min walking test is not a useful tool to identify subjects with increased risk of developing PPC following UAS.
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Affiliation(s)
- Denise M Paisani
- Respiratory Department, Federal University of São Paulo, São Paulo, Brazil.
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Borges H, Raquel DFDS, Batista PM, Quitério RJ, Ambrozin ARP. Efeitos do estímulo verbal sobre o desempenho no teste de escada e ajustes cardiorrespiratórios em sujeitos saudáveis. FISIOTERAPIA E PESQUISA 2012. [DOI: 10.1590/s1809-29502012000400013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Esta pesquisa teve o objetivo de avaliar os efeitos do estímulo verbal (EV) no tempo do teste de escada (TEsc) e nas variáveis cardiorrespiratórias de adultos saudáveis. Trinta e um adultos saudáveis realizaram dois TEsc (com EV e sem EV). Antes e depois de cada teste, foram avaliados os sinais vitais e a Escala de Borg. Os tempos nos TEsc foram comparados por meio do Teste t de Student para amostras pareadas e as diferenças, de acordo com a ordem de realização dos testes utilizando o Teste de Mann-Whitney. Os sinais vitais e a Escala de Borg foram comparados por meio do Teste de Friedman ou ANOVA com post hoc do Teste de Tukey. As variações foram comparadas utilizando o Teste t Student para amostras independentes ou Teste de Mann-Whitney (p<0,05). O tempo no TEsc sem EV foi de 23,48±8,28 segundos, significativamente maior que o teste com EV, que foi de 21,60±7,18 segundos (p<0,05). Todas as variáveis aumentaram após os testes, e a Escala de Borg foi a única que teve maior variação no TEsc com EV, variando 2,5±1,4 no teste sem estímulo e 3,0±1,8 pontos no com estímulo (p<0,05). O estímulo verbal melhora o desempenho no TEsc e leva à maior sensação de esforço.
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