Oxygen Use After Lung Cancer Surgery

Predictors of respiratory failure after thoracic surgery: a retrospective cohort study with comparison between lobar and sub-lobar resection

Objective

Only approximately 15% of patients with lung cancer are suitable for surgery and clinical postoperative outcomes vary. The aim of this study was to investigate variables associated with post-surgery respiratory failure in this patient cohort.

Methods

Patients who underwent surgery for lung cancer were retrospectively studied for respiratory function. All patients had undergone lung resection by a mini-thoracotomy approach. The study population was divided into two subgroups for comparison: lobectomy group, who underwent lobar resection; and sub-lobar resection group.

Results

A total of 85 patients were included, with a prevalence of lung cancer stage IA and adenocarcinoma histotype. Lobectomy (versus sub-lobar resection), the presence of chronic obstructive pulmonary disease (COPD), and a COPD assessment test (CAT) score >10, were all associated with an increased risk of respiratory failure. The partial pressure of arterial oxygen decreased more in the lobectomy group than in the sub-lobar resection group following surgery, with a significant postoperative between-group difference in values. Postoperative CAT scores were also better in the sub-lobar resection group.

Conclusions

Post-surgical variations in functional parameters were greater in the group treated by lobectomy. COPD, high CAT score and surgery type were associated with postoperative development of respiratory failure.

Effects of Smoking, Obesity, and Pulmonary Function on Home Oxygen Use after Curative Lung Cancer Surgery

RATIONALE

Lung cancer surgical morbidity has been decreasing, increasing attention to quality-of-life measures. A chronic sequela of lung cancer surgery is use of postoperative oxygen at home after discharge. Prospective studies are needed to identify risk predictors for home oxygen(HO2) use after curative lung cancer surgery.

OBJECTIVES

To prospectively assess risk factors for postoperative oxygen use and post-surgical morbidity in patients undergoing curative lung cancer surgery. We hypothesized that obesity, poor pre-operative pulmonary function, and smoking status would contribute to the risk of postoperative oxygen use.

METHODS

Patients undergoing surgery for first primary non-small cell lung cancer at Mount Sinai, from 2016 to 2020. Univariate, multivariable logistic regression analyses and adjusted odds ratio and 95% confidence intervals were assessed.

RESULTS

Of the 433 patients diagnosed with pathologic stage I non-small cell lung cancer, 63 (14.5%) were discharged with HO2. Using multivariable analyses, body mass index (OR for BMI25-30=4.0, 95% CI:1.6-11.2, p = 0.005 and OR for BMI≥ 30=6.1, 95% CI:2.4-17.5, p<0.001)and pre-operative diffusing capacity for carbon monoxide(DLCO) (OR for DLCO<40=24.9, 95% CI:3.6-234.1, p=0.002 and OR for DLCO 40-59=3.1, 95% CI:1.3-7.2, p=0.008) were significant independent risk factors associated with risk of home oxygen after controlling for other covariates. Although current smoking significantly increased the risk in the univariate analysis, it was no longer significant in the multivariable model.

CONCLUSIONS

Obesity and diffusing capacity for carbon monoxide were significant as risk factors for oxygen use at home after discharge. These findings allow for identification of patients at risk of being discharged with home oxygen after lung resection surgery.

The Survival Advantage of Lobectomy over Wedge Resection Lessens as Health-Related Life Expectancy Decreases

Introduction

Patients with early-stage NSCLC typically must choose between a surgery with superior local control (lobectomy) or one that preserves lung parenchyma (wedge). Recognizing that many patients with cancer have competing mortality risks unrelated to cancer, we investigated whether an established model of predicting life expectancy could be used to identify patients with stage I NSCLC for whom survival after wedge is not different from lobectomy.

Methods

A retrospective cohort study using the National Cancer Institute's Surveillance Epidemiology and End Results-Medicare was performed to evaluate survival among treatment-naive patients, diagnosed 2005-2015, who underwent lobectomy or wedge for stage I (≤2 cm tumors) NSCLC. Comorbidity-related life expectancy (CR-LE) was estimated using a standard life-table approach based on comorbid conditions, sex, and age. Cox models and perioperative complications were stratified by 5-year CR-LE.

Results

A total of 4560 patients (median age 74, interquartile range 70-78) were identified. CR-LE was greater than or equal to 5 years for 4016 patients (wedge = 23%). CR-LE was less than 5 years for 544 patients (wedge = 41%). Among patients with CR-LE greater than or equal to 5, wedge resection was associated with higher risk of mortality than lobectomy (hazard ratio: 1.68, 95% confidence interval: 1.52-1.86, p < 0.001). For those with CR-LE less than 5, there was no significant difference in mortality risk between lobectomy and wedge (hazard ratio: 1.19, 95% confidence interval: 0.96-1.47; p = 0.11). CR-LE less than five patients who underwent a lobectomy had higher 90-day mortality compared with wedge (9% versus 4%, p = 0.04).

Conclusion

The survival advantage of lobectomy over wedge for stage I NSCLC seems to dissipate among patients with shorter life expectancy owing to age and comorbidities. Wedge resection may be a reasonable option for patients at high risk of dying from non-cancer-related causes.