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Kristenson K, Hedman K. Percent predicted peak oxygen uptake is superior to weight-indexed peak oxygen uptake in risk stratification before lung cancer lobectomy. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00187-9. [PMID: 38452887 DOI: 10.1016/j.jtcvs.2024.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/16/2024] [Accepted: 02/22/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVE To improve preoperative risk stratification in lung cancer lobectomy by identifying and comparing optimal thresholds for peak oxygen uptake (VO2peak) presented as weight-indexed and percent of predicted values, respectively. METHODS This was a longitudinal cohort study including national registry data on patients scheduled for cancer lobectomy that used available data from preoperative cardiopulmonary exercise testing. The measured VO2peak was indexed by body mass (mL/kg/min) and also compared with 2 established reference equations (Wasserman-Hansen and Study of Health in Pomerania, respectively). By receiver operating characteristic analysis, a lower 90% specificity and an upper 90% sensitivity threshold were determined for each measure, in relation to the outcome of any major complication or death. For each measure and based on these thresholds, patients were categorized as low risk, intermediate risk, or high risk. The frequency of complications was compared between groups using χ2. RESULTS The frequency of complications differed significantly between the proposed low-, intermediate-, and high-risk groups when using % predicted Study of Health in Pomerania (5%, 21%, 35%, P = .007) or % predicted Wasserman-Hansen (5%, 25%, 35%, P = .002) but not when using the weight-indexed VO2peak groups (7%, 23%, 15%, P = .08). Nonsignificant differences were found using the threshold <15 mL/kg/min (P = .34). CONCLUSIONS This study showed that weight-indexed VO2peak was of less use as a marker of risk at the lower range of exercise capacity, whereas % predicted VO2peak was associated with a continuously increasing risk of major complications, also at the lower end of exercise capacity. As identifying subjects at high risk of complications is important, % predicted VO2peak is therefore preferable.
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Affiliation(s)
- Karolina Kristenson
- Department of Cardiothoracic and Vascular Surgery, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Kristofer Hedman
- Department of Clinical Physiology, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Falcoz PE, Olland A, Charloux A. Does functional evaluation before lung cancer surgery need reappraisal? Eur J Cardiothorac Surg 2021; 60:3-6. [PMID: 34113993 DOI: 10.1093/ejcts/ezab273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Pierre-Emmanuel Falcoz
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France.,Université de Strasbourg, Faculté de médecine et pharmacie, Strasbourg, France.,Hôpitaux Universitaire de Strasbourg, Service de chirurgie thoracique-Nouvel Hôpital Civil, Strasbourg, France.,Department of Thoracic Surgery, University Hospital, Strasbourg, France
| | - Anne Olland
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France.,Université de Strasbourg, Faculté de médecine et pharmacie, Strasbourg, France.,Hôpitaux Universitaire de Strasbourg, Service de chirurgie thoracique-Nouvel Hôpital Civil, Strasbourg, France.,Department of Thoracic Surgery, University Hospital, Strasbourg, France
| | - Anne Charloux
- Hôpitaux Universitaire de Strasbourg, Service de physiologie et explorations fonctionnelles-Nouvel Hôpital Civil, Strasbourg, France.,EA 3072, Federation of Translational Medicine, Strasbourg University, Strasbourg, France.,Physiology and Functional Explorations Dept, University Hospital, Strasbourg, France
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Piccioni F, Droghetti A, Bertani A, Coccia C, Corcione A, Corsico AG, Crisci R, Curcio C, Del Naja C, Feltracco P, Fontana D, Gonfiotti A, Lopez C, Massullo D, Nosotti M, Ragazzi R, Rispoli M, Romagnoli S, Scala R, Scudeller L, Taurchini M, Tognella S, Umari M, Valenza F, Petrini F. Recommendations from the Italian intersociety consensus on Perioperative Anesthesia Care in Thoracic surgery (PACTS) part 1: preadmission and preoperative care. Perioper Med (Lond) 2020; 9:37. [PMID: 33292657 PMCID: PMC7704118 DOI: 10.1186/s13741-020-00168-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 11/03/2020] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Anesthetic care in patients undergoing thoracic surgery presents specific challenges that necessitate standardized, multidisciplionary, and continuously updated guidelines for perioperative care. METHODS A multidisciplinary expert group, the Perioperative Anesthesia in Thoracic Surgery (PACTS) group, comprising 24 members from 19 Italian centers, was established to develop recommendations for anesthesia practice in patients undergoing thoracic surgery (specifically lung resection for cancer). The project focused on preoperative patient assessment and preparation, intraoperative management (surgical and anesthesiologic care), and postoperative care and discharge. A series of clinical questions was developed, and PubMed and Embase literature searches were performed to inform discussions around these areas, leading to the development of 69 recommendations. The quality of evidence and strength of recommendations were graded using the United States Preventative Services Task Force criteria. RESULTS Recommendations for preoperative care focus on risk assessment, patient preparation (prehabilitation), and the choice of procedure (open thoracotomy vs. video-assisted thoracic surgery). CONCLUSIONS These recommendations should help pulmonologists to improve preoperative management in thoracic surgery patients. Further refinement of the recommendations can be anticipated as the literature continues to evolve.
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Affiliation(s)
- Federico Piccioni
- Department of Critical and Supportive Care, Fondazione IRCCS Istituto Nazionale dei Tumori, via Venezian 1, 20133, Milan, Italy.
| | | | - Alessandro Bertani
- Division of Thoracic Surgery and Lung Transplantation, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS ISMETT - UPMC, Palermo, Italy
| | - Cecilia Coccia
- Department of Anesthesia and Critical Care Medicine, National Cancer Institute "Regina Elena"-IRCCS, Rome, Italy
| | - Antonio Corcione
- Department of Critical Care Area Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Angelo Guido Corsico
- Division of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation and Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Roberto Crisci
- Department of Thoracic Surgery, University of L'Aquila, L'Aquila, Italy
| | - Carlo Curcio
- Thoracic Surgery, AORN dei Colli Vincenzo Monaldi Hospital, Naples, Italy
| | - Carlo Del Naja
- Department of Thoracic Surgery, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, FG, Italy
| | - Paolo Feltracco
- Department of Medicine, Anaesthesia and Intensive Care, University Hospital of Padova, Padua, Italy
| | - Diego Fontana
- Thoracic Surgery Unit - San Giovanni Bosco Hospital - Torino, Turin, Italy
| | | | - Camillo Lopez
- Thoracic Surgery Unit, V Fazzi Hospital, Lecce, Italy
| | - Domenico Massullo
- Anesthesiology and Intensive Care Unit, Azienda Ospedaliero Universitaria S. Andrea, Rome, Italy
| | - Mario Nosotti
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Riccardo Ragazzi
- Department of Morphology, Surgery and Experimental Medicine, Azienda Ospedaliero-Universitaria Sant'Anna, Ferrara, Italy
| | - Marco Rispoli
- Anesthesia and Intensive Care, AORN dei Colli Vincenzo Monaldi Hospital, Naples, Italy
| | - Stefano Romagnoli
- Department of Health Science, Section of Anesthesia and Critical Care, University of Florence, Florence, Italy
- Department of Anesthesia and Critical Care, Careggi University Hospital, Florence, Italy
| | - Raffaele Scala
- Pneumology and Respiratory Intensive Care Unit, San Donato Hospital, Arezzo, Italy
| | - Luigia Scudeller
- Clinical Epidemiology Unit, Scientific Direction, Fondazione IRCCS San Matteo, Pavia, Italy
| | - Marco Taurchini
- Department of Thoracic Surgery, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, FG, Italy
| | - Silvia Tognella
- Respiratory Unit, Orlandi General Hospital, Bussolengo, Verona, Italy
| | - Marzia Umari
- Combined Department of Emergency, Urgency and Admission, Cattinara University Hospital, Trieste, Italy
| | - Franco Valenza
- Department of Critical and Supportive Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Department of Oncology and Onco-Hematology, University of Milan, Milan, Italy
| | - Flavia Petrini
- Department of Anaesthesia, Perioperative Medicine, Pain Therapy, RRS and Critical Care Area - DEA ASL2 Abruzzo, Chieti University Hospital, Chieti, Italy
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Simon D, Irusen EM, Warwick JM, Doruyter A, Koegelenberg CFN. Simple Anatomical Calculations Possibly As Accurate As Three-Dimensional Lobar Quantification with SPECT-CT in Predicting Lung Function after Pulmonary Resection. Respiration 2019; 98:82-85. [PMID: 31048582 DOI: 10.1159/000497462] [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: 12/10/2018] [Accepted: 01/31/2019] [Indexed: 11/19/2022] Open
Abstract
The estimation of predicted postoperative (PPO) lung function is important in lung resection candidates. We utilized simple anatomical calculations and single-photon emission computed tomography combined with computed tomography (SPECT-CT) to calculate PPO in 24 consecutive patients with impaired pulmonary function who underwent lung resection. PPO values calculated by anatomical calculations and three-dimensional lobar SPECT-CT quantification both correlated well with the postoperative forced expiratory volume in 1 s, with r = 0.825, p < 0.001 and r = 0.796, p < 0.001, respectively. Both techniques fared well at predicting postoperative lung function, but our observations unexpectedly suggested that simple anatomical calculations might be equivalent to three-dimensional SPECT-CT lobar quantification.
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Affiliation(s)
- Donald Simon
- Division of Pulmonology, Department of Medicine, Tygerberg Academic Hospital, Stellenbosch University, Cape Town, South Africa
| | - Elvis M Irusen
- Division of Pulmonology, Department of Medicine, Tygerberg Academic Hospital, Stellenbosch University, Cape Town, South Africa
| | - James M Warwick
- Division of Nuclear Medicine, Department of Medical Imaging and Clinical Oncology, Tygerberg Academic Hospital, Stellenbosch University, Cape Town, South Africa
| | - Alex Doruyter
- Division of Nuclear Medicine, Department of Medical Imaging and Clinical Oncology, Tygerberg Academic Hospital, Stellenbosch University, Cape Town, South Africa
| | - Coenraad F N Koegelenberg
- Division of Pulmonology, Department of Medicine, Tygerberg Academic Hospital, Stellenbosch University, Cape Town, South Africa,
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Lee SE, Cho WH, Lee SK, Byun KS, Son BS, Jeon D, Kim YS, Yeo HJ. Routine intensive monitoring but not routine intensive care unit-based management is necessary in video-assisted thoracoscopic surgery lobectomy for lung cancer. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:129. [PMID: 31157250 DOI: 10.21037/atm.2019.02.29] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Evidence for immediate postoperative intensive care unit (ICU) care is still lacking in the era of minimally invasive video-assisted thoracic surgery (VATS). We evaluated the safety and feasibility of general ward (GW) care after VATS lobectomy for lung cancer. Methods A total of 451 patients who underwent VATS lobectomy for lung cancer between June 2012 and August 2017 were retrospectively studied. The patients were divided into two groups (ICU 344 vs. GW 107). We compared the postoperative complications and mortality between the two groups after propensity score matching. Furthermore, we evaluated the clinical factors associated with complications, and stratified patients according to the risk for complications. Results Immediate complications (within 24 hours after surgery) occurred in 0.4%. Non-immediate complications occurred in 18.8%. There were no differences in the incidence of complications and mortality between the two groups, after propensity matching. However, the length of postoperative stay (12.6±10.0 vs. 10.3±4.1 days, P=0.041) was significantly higher in the ICU group than in the GW group. Multivariate regression analyses revealed that chronic obstructive pulmonary disease (COPD) [odds ratio (OR) =3.00, 95% confidence interval (CI): 1.51-5.97, P=0.002], non-stage I cancer (OR =2.54, 95% CI: 1.39-4.62, P=0.002), multi-port surgery (OR =3.75, 95% CI: 2.18-6.44, P<0.001), and age ≥60 years (OR =2.12, 95% CI: 1.03-4.37, P=0.042) were associated with complications. Immediate postoperative care in GW had no influence on complications. Conclusions Immediate postoperative care after VATS lobectomy for lung cancer in GW was safe and feasible without poor outcomes. Therefore, selective intensive monitoring for high risk groups may offer cost-saving and efficient use of ICU resources.
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Affiliation(s)
- Seung Eun Lee
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do 626-770, Republic of Korea
| | - Woo Hyun Cho
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do 626-770, Republic of Korea
| | - Sang Kwon Lee
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do 626-770, Republic of Korea
| | - Ki Sup Byun
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do 626-770, Republic of Korea
| | - Bong Soo Son
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do 626-770, Republic of Korea
| | - Doosoo Jeon
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do 626-770, Republic of Korea
| | - Yun Seong Kim
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do 626-770, Republic of Korea
| | - Hye Ju Yeo
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do 626-770, Republic of Korea
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Fernández-Rodríguez L, Torres I, Romera D, Galera R, Casitas R, Martínez-Cerón E, Díaz-Agero P, Utrilla C, García-Río F. Prediction of postoperative lung function after major lung resection for lung cancer using volumetric computed tomography. J Thorac Cardiovasc Surg 2018; 156:2297-2308.e5. [PMID: 30195604 DOI: 10.1016/j.jtcvs.2018.07.040] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 06/15/2018] [Accepted: 07/02/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The study objectives were to assess the accuracy of volumetric computed tomography to predict postoperative lung function in patients with lung cancer in relation to anatomic segments counting and perfusion scintigraphy, to generate specific predictive equations for each functional parameter, and to evaluate accuracy and precision of these in a validation cohort. METHODS We assessed pulmonary functions preoperatively and 3 to 4 months postoperatively after lung resection for lung cancer (n = 114). Absolute and relative lung volumes (total and upper/middle/lower) were determined using volumetric software analysis for staging thoracic computed tomography scans. Predicted postoperative function was calculated by segments counting, scintigraphy, and volumetric computed tomography. RESULTS Volumetric computed tomography achieves a higher correlation and precision with measured postoperative lung function than segments counting or scintigraphy (correlation and intraclass correlation coefficients, 0.779-0.969 and 0.776-0.969; 0.573-0.887 and 0.552-0.882; and 0.578-0.834 and 0.532-0.815, respectively), as well as greater accuracy, determined by narrower agreement coefficients for forced vital capacity, forced expiratory volume in 1 second, lung diffusing capacity, and peak oxygen uptake. After validation in an independent cohort (n = 43), adjusted linear regression including volumetric estimation of decreased postoperative ventilation for postoperative lung function parameters explains 98% to 99% of variance. CONCLUSIONS Volumetric computed tomography is a reliable and accurate method to predict postoperative lung function in patients undergoing lung resection that provides better accuracy than conventional procedures. Because lung computed tomography is systematically performed in the staging of patients with suspected lung cancer, this volumetric analysis might simultaneously provide the information necessary to evaluate operability.
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Affiliation(s)
| | - Isabel Torres
- Servicio de Radiodiagnóstico, Hospital Universitario La Paz, Madrid, Spain
| | - Delia Romera
- Servicio de Neumología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Raúl Galera
- Servicio de Neumología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Raquel Casitas
- Servicio de Neumología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Elisabet Martínez-Cerón
- Servicio de Neumología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Prudencio Díaz-Agero
- Servicio de Cirugía Torácica, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Cristina Utrilla
- Servicio de Radiodiagnóstico, Hospital Universitario La Paz, Madrid, Spain
| | - Francisco García-Río
- Servicio de Neumología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; CIBER de Enfermedades Respiratorias, Madrid, Spain; Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain.
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Apurva A, Tandon SP, Shetmahajan M, Jiwnani SS, Karimundackal G, Pramesh CS. Surgery for lung cancer—the Indian scenario. Indian J Thorac Cardiovasc Surg 2018. [DOI: 10.1007/s12055-017-0634-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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The five commandments of efficient and effective care in the initial evaluation of lung cancer. Curr Opin Pulm Med 2017; 22:319-26. [PMID: 27055074 DOI: 10.1097/mcp.0000000000000281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Multiple recent studies have found an astounding lack of concordance with national guidelines in the workup of lung cancer in both community and academic settings. The resultant increase in complications and delays may potentially contribute to the overall dismal outcomes, as well as cost. This article aims to increase awareness among clinicians about the scope of this problem, and provides a simplified primer on the core concepts of how to perform an efficient and effective workup that is in-line with national guidelines. RECENT FINDINGS Although the basic principles underlying lung cancer evaluation have not changed in the last decade, there are new areas of debate which are outlined and discussed in this article. These include: the value of brain and bone imaging in asymptomatic patients, the best initial site to biopsy in the era of genomics, and the use of biomarkers with low-dose chest tomography screening. SUMMARY Given the huge stakes in lung cancer, the current national quality gap in initial evaluation is unacceptable. However, physician re-education can change this. This article provides a quick review of how to properly evaluate a patient with potential lung cancer, as well as an update on new and continuing controversies in the field.
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Bahig H, Campeau MP, Lapointe A, Bedwani S, Roberge D, de Guise J, Blais D, Vu T, Lambert L, Chartrand-Lefebvre C, Lord M, Filion E. Phase 1-2 Study of Dual-Energy Computed Tomography for Assessment of Pulmonary Function in Radiation Therapy Planning. Int J Radiat Oncol Biol Phys 2017; 99:334-343. [DOI: 10.1016/j.ijrobp.2017.05.051] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 04/24/2017] [Accepted: 05/30/2017] [Indexed: 12/25/2022]
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Zhang Z, Mostofian F, Ivanovic J, Gilbert S, Maziak DE, Shamji FM, Sundaresan S, Villeneuve PJ, Seely AJE. All grades of severity of postoperative adverse events are associated with prolonged length of stay after lung cancer resection. J Thorac Cardiovasc Surg 2017; 155:798-807. [PMID: 29103816 DOI: 10.1016/j.jtcvs.2017.09.094] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 08/28/2017] [Accepted: 09/16/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine whether all grades of severity of postoperative adverse events are associated with prolonged length of stay in patients undergoing pulmonary cancer resection. METHODS This was a retrospective cohort study of all patients who underwent pulmonary resection with curative intent for malignancy at The Ottawa Hospital, Division of Thoracic Surgery (January 2008 to July 2015). Postoperative adverse events were collected prospectively with the Thoracic Morbidity & Mortality System, based on the Clavien-Dindo severity classification. Patient demographics, comorbidities, preoperative investigations, cardiopulmonary assessment, pathologic staging, operative characteristics, and length of stay were retrospectively reviewed. Prolonged hospital stay was defined as >75th percentile for each procedure performed (wedge resection 6 days, segmentectomy 6 days, lobectomy 7 days, extended lobectomy 8 days, pneumonectomy 10 days). Univariable and multivariable logistic regression analyses were conducted to identify factors associated with prolonged hospital stay. RESULTS Of 1041 patients, 579 (55.6%) were female, 610 (58.1%) were >65 years old, 232 (22.3%) experienced prolonged hospital stay, and 416 (40.0%) patients had ≥1 postoperative adverse event. Multivariable analyses identified significant (P < .05) factors associated with prolonged hospital stay to be (odds ratio; 95% confidence interval): lower diffusion capacity of the lung for carbon monoxide (0.99; 0.98-0.99), surgical approach: open thoracotomy (1.8; 1.3-2.5), and presence of any postoperative adverse event: Grade I (5.8; 3.3-10.2), Grade II (6.0; 4.0-8.9), Grade III (11.4; 7.0-18.7), and Grade IV (19.40; 7.1-55.18). CONCLUSIONS Lower diffusion capacity of the lung for carbon monoxide, open thoracotomy approach, and the development of any postoperative adverse event, including minor events that required no additional therapy, were factors associated with prolonged hospital stay.
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Affiliation(s)
- Zach Zhang
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Fargol Mostofian
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jelena Ivanovic
- School of Epidemiology, Public Health, and Preventative Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Sebastien Gilbert
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Division of Thoracic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Donna E Maziak
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; School of Epidemiology, Public Health, and Preventative Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Division of Thoracic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Farid M Shamji
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Division of Thoracic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Sudhir Sundaresan
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Division of Thoracic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Patrick J Villeneuve
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Division of Thoracic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Andrew J E Seely
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; School of Epidemiology, Public Health, and Preventative Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Division of Thoracic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.
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Fourdrain A, De Dominicis F, Lafitte S, Iquille J, Prevot F, Lorne E, Monconduit J, Bagan P, Berna P. Quantitative computed tomography to predict postoperative FEV1 after lung cancer surgery. J Thorac Dis 2017; 9:2413-2418. [PMID: 28932546 DOI: 10.21037/jtd.2017.06.118] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Predicted postoperative FEV1 (ppoFEV1) must be estimated preoperatively prior to surgery for non-small cell lung cancer (NSCLC). We evaluated a lung volumetry approach based on chest computed tomography (CT). METHODS A prospective study was conducted over a period of one year in eligible lung cancer patients to evaluate the difference between ppoFEV1 and the 3-month postoperative FEV1 (poFEV1). Patients in whom CT was performed in another hospital and those with factors influencing poFEV1, such as atelectasis, pleural effusion, pneumothorax, or pneumonia, were excluded. A total of 23 patients were included and ppoFEV1 was calculated according to 4 usual Methods: Nakahara formula, Juhl and Frost formula, ventilation scintigraphy, perfusion scintigraphy, and a fifth method based on quantitative CT. Lung volume was calculated twice and separately by 2 radiologists. Tumor volume, and emphysema defined by a -950 HU limit were subtracted from the total lung volume in order to estimate ppoFEV1. RESULTS We compared 5 methods of ppoFEV1 estimation and calculated the mean volume difference between ppoFEV1 and poFEV1. A better correlation was observed for quantitative CT than for Nakahara formula, Juhl and Frost formula, perfusion scintigraphy and ventilation scintigraphy with respectively: R2=0.79 vs. 0.75, 0.75, 0.67 and 0.64 with a mean volume difference of 266±229 mL (P<0.01) vs. 320±262 mL (P<0.01), 332±251 mL (P<0.01), 304±295 mL (P<0.01) and 312±303 mL (P<0.01). CONCLUSIONS Quantitative CT appears to be a satisfactory method to evaluate ppoFEV1 evaluation method, and appears to be more reliable than other approaches. Estimation of ppoFEV1, as part of the preoperative assessment, does not involve additional morphologic examinations, particularly scintigraphy. This method may become the reference method for ppoFEV1 evaluation.
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Affiliation(s)
- Alex Fourdrain
- Department of Thoracic Surgery, Amiens University Hospital, University of Picardy, F-80054 Amiens Cedex 01, France
| | - Florence De Dominicis
- Department of Thoracic Surgery, Amiens University Hospital, University of Picardy, F-80054 Amiens Cedex 01, France
| | - Sophie Lafitte
- Department of Thoracic Surgery, Amiens University Hospital, University of Picardy, F-80054 Amiens Cedex 01, France
| | - Jules Iquille
- Department of Thoracic Surgery, Amiens University Hospital, University of Picardy, F-80054 Amiens Cedex 01, France
| | - Flavien Prevot
- Department of Digestive Surgery, Amiens University Hospital, University of Picardy, F-80054 Amiens Cedex 01, France
| | - Emmanuel Lorne
- Department of Anesthesiology, Amiens University Hospital, University of Picardy, F-80054 Amiens Cedex 01, France
| | - Julien Monconduit
- Department of Thoracic Surgery, Amiens University Hospital, University of Picardy, F-80054 Amiens Cedex 01, France
| | - Patrick Bagan
- Department of Thoracic Surgery, Amiens University Hospital, University of Picardy, F-80054 Amiens Cedex 01, France
| | - Pascal Berna
- Department of Thoracic Surgery, Amiens University Hospital, University of Picardy, F-80054 Amiens Cedex 01, France
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Cañizares Carretero MÁ, García Fontán EM, Blanco Ramos M, Soro García J, Carrasco Rodríguez R, Peña González E, Cueto Ladrón de Guevara A. Is age a predisposing factor of postoperative complications after lung resection for primary pulmonary neoplasms? Cir Esp 2017; 95:160-166. [PMID: 28347487 DOI: 10.1016/j.ciresp.2017.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 02/05/2017] [Accepted: 02/19/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Age has been classically considered as a determining factor for the development of postoperative complications related to lung resection for bronchogenic carcinoma. The Postoperative Complications Study Group of the Spanish Society of Thoracic Surgery has promoted a registry to analyze this factor. METHODS A total of 3,307 patients who underwent any type of surgical resection for bronchogenic carcinoma have been systematically and prospectively recorded in any of the 24 units that are part of the group. Several variables related to comorbidity and age, as well as postoperative complications, were analyzed. RESULTS The mean age of patients was 65,44. Men were significantly more common than female. The most frequent complication was prolonged air leak, which was observed in more than one third of patients. In a univariant analysis, air leak presence and postsurgical atelectasis showed statistical association with patient age, when stratified in age groups. In a multivariate analysis, age was recognized as an independent prognostic factor in relation to air leak onset. However, this could not be confirmed for postoperative atelectasis. CONCLUSION Age is a predisposing factor for the development of postoperative complications after lung resection. Other associated factors also influence the occurrence of these complications.
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Affiliation(s)
| | | | | | - José Soro García
- Servicio de Cirugía Torácica, Hospital Álvaro Cunqueiro, Vigo, España
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Choe J, Lee SM, Chae EJ, Lee SM, Kim YH, Kim N, Seo JB. Evaluation of postoperative lung volume and perfusion changes by dual-energy computed tomography in patients with lung cancer. Eur J Radiol 2017; 90:166-173. [PMID: 28583629 DOI: 10.1016/j.ejrad.2017.02.040] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 02/22/2017] [Accepted: 02/27/2017] [Indexed: 12/25/2022]
Abstract
PURPOSE The aim of our study was to retrospectively evaluate postoperative physiologic changes in lung cancer patients using dual-energy CT (DECT), and develop modified methods reflecting postoperative change for predicting pulmonary function. METHODS AND MATERIALS 88 patients (M:F=64:24; mean age, 63.5 years) with lung cancer who underwent DECT and pulmonary function tests before and after operation were included. Volume and iodine values for perfusion of each lobe were quantified. The predicted postoperative FEV1 using the current method was calculated by multiplying the preoperative FEV1 by the fractional contribution of perfusion of the remaining lung. The modified method reflecting postoperative volume change was compared to the current method. RESULTS Postoperative lung volume showed compensatory increases in the contralateral and remaining ipsilateral lobes, with a significantly greater increase in the ipsilateral lobe than contralateral lobe (21.8%±46.2% vs. 10.0%±20.8%, P=0.031). Perfusion analysis showed blood volume increases in both ipsilateral and contralateral lobes without statistical differences (blood volume ratio difference, 29.2%±26.7 vs. 24.6%±16.5, P=0.368). The performance of the modified method considering postoperative lung volume change was comparable to that of the current method in the development and validation datasets (95% CI, -24.5% to 37.1% vs. -33.3% to 22.2% and -23.6% to 32.0% vs. -31.9% to 16.0%, respectively). CONCLUSIONS Postoperative compensatory increases in lung volume and perfusion occur in different ways. Our modified method incorporating postoperative lung volume changes can be considered a comparable method for prediction of postoperative lung function.
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Affiliation(s)
- Jooae Choe
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul 138-736, Republic of Korea.
| | - Sang Min Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul 138-736, Republic of Korea.
| | - Eun Jin Chae
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul 138-736, Republic of Korea.
| | - Sang Min Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul 138-736, Republic of Korea.
| | - Yong-Hee Kim
- Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
| | - Namkug Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul 138-736, Republic of Korea.
| | - Joon Beom Seo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul 138-736, Republic of Korea.
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Jean RA, DeLuzio MR, Kraev AI, Wang G, Boffa DJ, Detterbeck FC, Wang Z, Kim A. Analyzing Risk Factors for Morbidity and Mortality after Lung Resection for Lung Cancer Using the NSQIP Database. J Am Coll Surg 2016; 222:992-1000.e1. [DOI: 10.1016/j.jamcollsurg.2016.02.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 02/19/2016] [Accepted: 02/22/2016] [Indexed: 10/22/2022]
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Rodrigues F, Grafino M, Faria I, Pontes da Mata J, Papoila AL, Félix F. Surgical risk evaluation of lung cancer in COPD patients - A cohort observational study. REVISTA PORTUGUESA DE PNEUMOLOGIA 2016; 22:266-72. [PMID: 27174411 DOI: 10.1016/j.rppnen.2016.02.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 02/14/2016] [Accepted: 02/29/2016] [Indexed: 12/25/2022] Open
Abstract
Coexistence between pulmonary cancer and chronic obstructive pulmonary disease (COPD) is frequent and is anticipated to be lead to high worldwide mortality in the next decades. The most powerful therapeutic approach for non-small cell lung carcinoma is lung surgical resection. However, in COPD patients, this approach bears a higher mortality and morbidity risk, thus requiring an accurate pre-operatory evaluation of the surgical risk comprising a clinical and functional assessment at rest, as well as a cardiopulmonary exercise test. In this observational study, factors associated with cardiopulmonary complications within 30 days after tumor resection surgery were investigated in a cohort of patients with COPD and lung cancer assigned to perform a cardiopulmonary exercise test. This study included 50 patients (46 men, 92.0%) with a mean age of 64.7 years old (standard deviation 7.9), forced expiratory volume in the first second (FEV1) of 61.8% (SD 19.0%) and carbon monoxide diffusing capacity (DLCO) of 46.0% (SD 14.8%). Complications were observed in eighteen patients (36.0%) including 2 deaths (4.0%). Peak oxygen uptake (VO2peak) expressed in percentage of the predicted value was the only parameter showing a statistically significant difference between the groups with and without complications (p=0.027). The best value of VO2peak to discriminate complications occurrence was 61.0%. This study highlights the relevance of the cardiopulmonary exercise test in the risk assessment of pulmonary resection surgery in patients with COPD. The VO2peak (percentage of predicted value) is shown to be associated with complications within 30 days after surgery.
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Affiliation(s)
- F Rodrigues
- Serviço de Pneumologia, Hospital Pulido Valente, Centro Hospitalar Lisboa Norte, Portugal; Faculdade de Medicina, Universidade de Lisboa, Portugal.
| | - M Grafino
- Serviço de Pneumologia, Hospital Pulido Valente, Centro Hospitalar Lisboa Norte, Portugal
| | - I Faria
- Serviço de Pneumologia, Hospital Pulido Valente, Centro Hospitalar Lisboa Norte, Portugal
| | - J Pontes da Mata
- Serviço de Pneumologia, Hospital Pulido Valente, Centro Hospitalar Lisboa Norte, Portugal
| | - A L Papoila
- NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Portugal; Centro de Estatística e Aplicações da Universidade de Lisboa, Portugal
| | - F Félix
- Serviço de Cirurgia Torácica, Hospital Pulido Valente, Centro Hospitalar Lisboa Norte, Portugal
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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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Ohno Y, Seki S, Koyama H, Yoshikawa T, Matsumoto S, Takenaka D, Kassai Y, Yui M, Sugimura K. 3D ECG- and respiratory-gated non-contrast-enhanced (CE) perfusion MRI for postoperative lung function prediction in non-small-cell lung cancer patients: A comparison with thin-section quantitative computed tomography, dynamic CE-perfusion MRI, and perfus. J Magn Reson Imaging 2014; 42:340-53. [DOI: 10.1002/jmri.24800] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Accepted: 10/24/2014] [Indexed: 12/25/2022] Open
Affiliation(s)
- Yoshiharu Ohno
- Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine; Kobe Japan
- Division of Functional and Diagnostic Imaging Research, Department of Radiology; Kobe University Graduate School of Medicine; Kobe Japan
| | - Shinichiro Seki
- Division of Radiology, Department of Radiology; Kobe University Graduate School of Medicine; Kobe Japan
| | - Hisanobu Koyama
- Division of Radiology, Department of Radiology; Kobe University Graduate School of Medicine; Kobe Japan
| | - Takeshi Yoshikawa
- Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine; Kobe Japan
- Division of Functional and Diagnostic Imaging Research, Department of Radiology; Kobe University Graduate School of Medicine; Kobe Japan
| | - Sumiaki Matsumoto
- Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine; Kobe Japan
- Division of Functional and Diagnostic Imaging Research, Department of Radiology; Kobe University Graduate School of Medicine; Kobe Japan
| | - Daisuke Takenaka
- Division of Radiology, Department of Radiology; Kobe University Graduate School of Medicine; Kobe Japan
- Department of Radiology; Hyogo Cancer Center; Akashi Japan
| | | | - Masao Yui
- Toshiba Medical Systems Corporation; Otawara Japan
| | - Kazuro Sugimura
- Division of Radiology, Department of Radiology; Kobe University Graduate School of Medicine; Kobe Japan
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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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Risk assessment of lung resection for lung cancer according to pulmonary function: republication of systematic review and proposals by guideline committee of the Japanese Association for Chest Surgery 2014. Gen Thorac Cardiovasc Surg 2014; 63:14-21. [DOI: 10.1007/s11748-014-0475-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Indexed: 12/25/2022]
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Fang Y, Ma G, Lou N, Liao W, Wang D. Preoperative Maximal Oxygen Uptake and Exercise-induced Changes in Pulse Oximetry Predict Early Postoperative Respiratory Complications in Lung Cancer Patients. Scand J Surg 2014; 103:201-208. [PMID: 24520103 DOI: 10.1177/1457496913509235] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Postoperative respiratory complications often arise in lung cancer patients after lung resection, although these are often difficult to predict. We sought to identify reliable predictors of early-onset postoperative respiratory complications in lung cancer patients who had moderate-to-severe preoperative respiratory impairment. METHODS This was a prospective observational study that included 107 consecutive lung cancer patients with forced expiratory volume in 1 s <60% of predicted who were scheduled for thoracotomy and lung resection. Preoperative functional assessments included pulmonary function testing by spirometry, single breath diffusion capacity of lung for carbon monoxide, and cardiopulmonary exercise testing. Risk factors for early-onset postoperative respiratory complications that occurred within 30 days postoperatively were sought from among these pulmonary function testing and cardiopulmonary exercise testing results. RESULTS By multivariable logistic regression, peak oxygen uptake (V'O2max%; p < 0.001) and the transcutaneous pulse oxygen saturation difference during load exercise (ΔSPO2%; p < 0.001) were independent predictors of postoperative respiratory complications. A receiver operating characteristic curve had an area under the curve of 0.846 for the combination of V'O2max% and ΔSPO2%, while the area under the curve with V'O2max% only was 0.726. From this, the probability of postoperative respiratory complications was [Formula: see text]. Pcomplication ≥ 0.202 for postoperative respiratory complications had a sensitivity of 80.8% and a specificity of 81.5%. CONCLUSIONS For lung cancer patients with forced expiratory volume in 1 s <60% of predicted, in addition to common preoperative tests, V'O2max% and ΔSPO2% may be an aid for predicting early-onset postoperative respiratory complications.
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Affiliation(s)
- Y Fang
- State Key Laboratory of Oncology in South China, Guangzhou, China Pulmonary Function Laboratory, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - G Ma
- State Key Laboratory of Oncology in South China, Guangzhou, China Intensive Care Unit, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - N Lou
- State Key Laboratory of Oncology in South China, Guangzhou, China Intensive Care Unit, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - W Liao
- State Key Laboratory of Oncology in South China, Guangzhou, China Intensive Care Unit, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - D Wang
- State Key Laboratory of Oncology in South China, Guangzhou, China Intensive Care Unit, Sun Yat-sen University Cancer Center, Guangzhou, China
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Novoa N, Jimenez MF, Aranda JL, Rodriguez M, Ramos J, Gomez Hernandez MT, Varela G. Effect of implementing the European guidelines for functional evaluation before lung resection on cardiorespiratory morbidity and 30-day mortality in lung cancer patients: a case-control study on a matched series of patients. Eur J Cardiothorac Surg 2014; 45:e89-93; discussion e93. [DOI: 10.1093/ejcts/ezt596] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] 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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Degani-Costa LH, Faresin SM, dos Reis Falcão LF. Preoperative evaluation of the patient with pulmonary disease. Braz J Anesthesiol 2013; 64:22-34. [PMID: 24565385 DOI: 10.1016/j.bjane.2012.11.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 11/19/2012] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND OBJECTIVES In daily clinical practice, pulmonary complications related to surgical procedure are common, increasing the morbidity and mortality of patients. Assessment of the risk of pulmonary complications is an important step in the preoperative evaluation. Thus, we review the most relevant aspects of preoperative assessment of the patient with lung disease. CONTENT Pulmonary risk stratification depends on clinical symptoms and patient's physical status. Age, preexisting respiratory diseases, nutritional status, and continued medical treatment are usually more important than additional tests. Pulmonary function tests are of great relevance when high abdominal or thoracic procedures are scheduled, particularly when lung resection are considered. CONCLUSION Understanding the perioperative evaluation of the potential risk for developing pulmonary complication allows the medical team to choose the adequate anesthetic technique and surgical and clinical care required by each patient, thereby reducing adverse respiratory outcomes.
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Affiliation(s)
- Luiza Helena Degani-Costa
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil; Massachusetts General Hospital, Harvard Medical School, MA, USA
| | - Sonia Maria Faresin
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Luiz Fernando dos Reis Falcão
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil; Massachusetts General Hospital, Harvard Medical School, MA, USA.
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Lemyze M, Dharancy S, Wallaert B. Response to exercise in patients with liver cirrhosis: implications for liver transplantation. Dig Liver Dis 2013; 45:362-6. [PMID: 23137795 DOI: 10.1016/j.dld.2012.09.022] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 09/10/2012] [Accepted: 09/30/2012] [Indexed: 12/11/2022]
Abstract
End-stage liver cirrhosis is a systemic disease carrying a short-term desperate prognosis without liver transplantation. Given the discrepancy between the growing number of candidates and the limited available liver grafts, the pre-transplantation screening process has become a challenging task. Cardiopulmonary exercise testing, by measuring maximal oxygen consumption at peak exercise, provides a global integrative approach of the health status of an individual. In the setting of liver cirrhosis, decreased oxygen consumption at peak exercise may result from a combination of multiple extra-hepatic complications, including deconditioning, malnutrition-associated muscle weakness, anaemia, cirrhotic cardiomyopathy, and hepato-pulmonary syndrome for instance. In addition, oxygen consumption at peak exercise not only correlated with the severity of the liver disease, but it is also independently associated with survival following liver transplantation. The present article aims to review the numerous determinants of impaired aerobic capacity in patients with severe liver disease, and to discuss how useful is cardiopulmonary exercise testing as a critical tool in the pre-transplantation assessment of these patients.
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Affiliation(s)
- Malcolm Lemyze
- Department of Respiratory and Critical Care Medicine, Schaffner Hospital, Lens, France.
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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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Voduc N. Physiology and clinical applications of cardiopulmonary exercise testing in lung cancer surgery. Thorac Surg Clin 2013; 23:233-45. [PMID: 23566975 DOI: 10.1016/j.thorsurg.2013.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cardiopulmonary exercise testing (CPET) permits measurement of oxygen uptake (Vo2), an indicator of overall cardiopulmonary fitness and a useful measurement in the assessment of operative risk for lung cancer patients. The evidence supporting the use of CPET in pre-operative assessment of the lung cancer surgery patient is examined. CPET methodology and limitations, as well as alternatives to CPET for risk assessment are discussed.
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Affiliation(s)
- Nha Voduc
- Division of Respirology, University of Ottawa, Ottawa Hospital, General campus, 501 Smyth Road, Mailbox 211, Ottawa, Ontario K1H 8L6, Canada.
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Guerra M, Neves P, Miranda J. Surgical treatment of non-small-cell lung cancer in octogenarians. Interact Cardiovasc Thorac Surg 2013; 16:673-80. [PMID: 23396622 DOI: 10.1093/icvts/ivt020] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Reluctance to recommend lung cancer surgery for octogenarians is partly based on the expectation that the rate of complications and mortality is higher in this group of patients, and on the impression that the life expectancy of an octogenarian with lung cancer is limited by death from natural causes. Moreover, the belief that radiation therapy and observation yield similar results to surgery in early-stage disease have influenced low resection rates in this population. Nevertheless, advances in surgical techniques, anaesthesia and postoperative care have made surgical lung resection a safer procedure than it was in the past. Judging from the more recent findings, surgery should not be withheld because of postoperative mortality, but suboptimal or palliative treatment may be necessary in patients with poor physical or mental function. To enable informed decision-making, both patients and clinicians need information on the risks of surgical treatment. In this review, available information from the literature was collected in an effort to understand the real benefit of surgical treatment in octogenarians with non-small-cell lung cancer, and to determine what should be done or avoided during the selection course.
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Affiliation(s)
- Miguel Guerra
- Department of Cardiothoracic Surgery, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nove de Gaia, Portugal.
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Welter S, Cheufou D, Ketscher C, Darwiche K, Maletzki F, Stamatis G. Risk factors for impaired lung function after pulmonary metastasectomy: a prospective observational study of 117 cases. Eur J Cardiothorac Surg 2012; 42:e22-7. [PMID: 22798338 DOI: 10.1093/ejcts/ezs293] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES The prediction of postoperative preserved pulmonary function is essential for ascertaining the functional operability of pulmonary metastasectomy candidates. Formulae to predict pulmonary function after metastasectomy have not yet been described. This study was undertaken to provide data about the functional loss after a pulmonary metastasectomy, which often includes non-anatomical resections or combinations with anatomical resections. METHODS Pulmonary function tests were performed preoperatively, postoperatively and 3 months after a pulmonary metastasectomy, and the factors potentially influencing the functional outcome were prospectively collected in a database. The functional loss was calculated as the difference in the values between the follow-up visit and the preoperative values, and the influencing factors were tested using the Mann-Whitney test. RESULTS A total of 162 patients were prospectively included in the study and 117 completed the study protocol with a follow-up evaluation after a mean of 3.4 months. Of these, 33 patients had bilateral resections, 30 interventions were repeated resections and adhesions were removed in 46. The greatest lung resection performed was a lobectomy in 13, with segmentectomy in 27 and wedge resection in 77 patients. The mean overall functional loss was: forced vital capacity -9.2%, total lung capacity -8.8%, forced expiratory volume in 1 s -10.8% and diffusion capacity for carbon monoxide (DLCO) -9.7%, whereas the diffusion coefficient (KCO) and pO(2) remained unchanged after 3 months. This functional loss was significant (P < 0.001) for all the parameters mentioned. The two factors were inversely found to influence the functional outcome: bilateral resection reduced spirometry values (P < 0.01), postoperative chemotherapy reduced DLCO (P = 0.011) and KCO (P = 0.029). CONCLUSIONS A pulmonary metastasectomy leads to a significant loss of pulmonary function after 3 months in an average patient collective. The most important factors for deteriorating lung function are a bilateral operation and postoperative chemotherapy.
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Affiliation(s)
- Stefan Welter
- Department of Thoracic Surgery, Ruhrlandklinik Essen, Essen, Germany.
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Abstract
A bronchial sleeve resection can be considered for lesions arising from a lobar bronchus so as to preclude a standard lobectomy, yet without enough distal involvement as to warrant a pneumonectomy. Limited bronchial resection allows maximal conservation of pulmonary function in patients with benign or malignant disease, without compromising oncologic outcome. This article defines the indications and preoperative management of candidate patients and discusses key anesthetic considerations and surgical techniques for this complex airway reconstruction. The essential component of a successful operation is a tension-free bronchial anastomosis. Open communication and careful discussion of airway management between anesthesiologist and surgeon will help ensure a good outcome.
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Affiliation(s)
- Jessica A. Yu
- University of Colorado Denver School of Medicine, Aurora, CO, USA
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Giroux Leprieur E, Labrune S, Giraud V, Gendry T, Cobarzan D, Chinet T. Delay between the initial symptoms, the diagnosis and the onset of specific treatment in elderly patients with lung cancer. Clin Lung Cancer 2012; 13:363-8. [PMID: 22264658 DOI: 10.1016/j.cllc.2011.11.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Revised: 11/13/2011] [Accepted: 11/14/2011] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The proportion of elderly patients with lung cancer is increasing. The objectives of this study were to describe the initial symptoms in elderly patients (≥ 70 years) with lung cancer and to describe the diagnostic and treatment delays. PATIENTS AND METHODS We reviewed all consecutive patients with lung cancer that were diagnosed between 2006 and 2008 in our department. The initial symptoms and delays in the diagnosis and treatment in elderly patients were compared with those of younger patients. RESULTS One hundred ninety-three patients were included (26 small-cell cancers and 167 non-small-cell lung cancers [NSCLCs]). Ninety-two patients (47.7%) were ≥ 70 years old. No statistical differences were identified between the 2 groups concerning initial symptoms. In elderly patients, the delay between the initial symptoms and the first visit with a thoracic oncologist (median 1.6 months [IQR 23 days-3.3 months]), the delay between the first visit and the specific treatment (median 1.1 months [IQR 18 days-1.8 months]), and the delay between initial symptoms and the specific treatment (median 3 months [IQR 2-5.7 months]) were similar to those in the younger patients (P = .101, P = .084, and P = .671, respectively). Eighty-four percent of the elderly patients were actively treated vs. 98% of the younger patients (P = .001). CONCLUSION We identified no differences regarding the initial symptoms in elderly patients with lung cancer compared with those in younger patients. The delays in diagnosis and treatment were similar between the 2 groups.
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MESH Headings
- Adenocarcinoma/diagnosis
- Adenocarcinoma/mortality
- Adenocarcinoma/therapy
- Adult
- Aged
- Aged, 80 and over
- Carcinoma, Large Cell/diagnosis
- Carcinoma, Large Cell/mortality
- Carcinoma, Large Cell/therapy
- Carcinoma, Non-Small-Cell Lung/diagnosis
- Carcinoma, Non-Small-Cell Lung/mortality
- Carcinoma, Non-Small-Cell Lung/therapy
- Carcinoma, Squamous Cell/diagnosis
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/therapy
- Combined Modality Therapy
- Delayed Diagnosis/statistics & numerical data
- Female
- Follow-Up Studies
- Humans
- Lung Neoplasms/diagnosis
- Lung Neoplasms/mortality
- Lung Neoplasms/therapy
- Male
- Middle Aged
- Neoplasm Staging
- Practice Guidelines as Topic/standards
- Prognosis
- Retrospective Studies
- Small Cell Lung Carcinoma/diagnosis
- Small Cell Lung Carcinoma/mortality
- Small Cell Lung Carcinoma/therapy
- Survival Rate
- Time Factors
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Affiliation(s)
- Etienne Giroux Leprieur
- Department of Pulmonary Diseases, Hopital Ambroise Pare, AP-HP, 9 avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France.
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von Groote-Bidlingmaier F, Koegelenberg CFN, Bolliger CT. Functional evaluation before lung resection. Clin Chest Med 2011; 32:773-82. [PMID: 22054885 DOI: 10.1016/j.ccm.2011.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Lung cancer is the leading cause of cancer-related death worldwide, and lung resection remains the only curative approach. In the Western world, lung cancer is one of the main indications for lung resection, despite only 15% to 25% of all lung cancers being operable at the time of presentation. In most cases of operable lung cancer, a substantial part of functional lung tissue has to be resected, leading to a permanent loss of pulmonary function. Resection in patients with insufficient pulmonary reserves can result in permanent respiratory disability. This article reviews the current standards of preoperative assessment.
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Affiliation(s)
- Florian von Groote-Bidlingmaier
- Division of Pulmonology, Department of Medicine, University of Stellenbosch, PO Box 19063, Tygerberg 7505, Cape Town, South Africa
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Park SY, Park IK, Hwang Y, Byun CS, Bae MK, Lee CY. Immediate Postoperative Care in the General Thoracic Ward Is Safe for Low-risk Patients after Lobectomy for Lung Cancer. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2011; 44:229-35. [PMID: 22263157 PMCID: PMC3249308 DOI: 10.5090/kjtcs.2011.44.3.229] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Revised: 12/30/2010] [Accepted: 05/10/2011] [Indexed: 11/23/2022]
Abstract
Background Following major lung resection, patients have routinely been monitored in the intensive care unit (ICU). Recently, however, patients are increasingly being placed in a general thoracic ward (GTW). We investigated the safety and efficacy of the GTW care after lobectomy for lung cancer. Materials and Methods 316 patients who had undergone lobectomy for lung cancer were reviewed. These patients were divided into two groups: 275 patients were cared for in the ICU while 41 patients were care for in the GTW immediately post-operation. After propensity score matching, postoperative complications and hospital costs were analyzed. Risk factors for early complications were analyzed with the whole cohort. Results Early complications (until the end of the first postoperative day) occurred in 11 (3.5%) patients. Late complications occurred in 42 patients (13.3%). After propensity score matching, the incidence of early complications, late complications, and mortality were not different between the two groups. The mean expense was higher in the ICU group. Risk factors for early complications were cardiac comorbidities and low expected forced expiratory volume in one second. The location of postoperative care had no influence on outcome. Conclusion Immediate postoperative care after lobectomy for lung cancer in a GTW was safe and cost-effective without compromising outcomes in low-risk patients.
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Affiliation(s)
- Seong Yong Park
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Korea
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Puente-Maestú L, Villar F, González-Casurrán G, Moreno N, Martínez Y, Simón C, Peñalver R, González-Aragoneses F. Early and Long-term Validation of an Algorithm Assessing Fitness for Surgery in Patients With Postoperative FEV 1 and Diffusing Capacity of the Lung for Carbon Monoxide < 40%. Chest 2011; 139:1430-1438. [DOI: 10.1378/chest.10-1069] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Fernandes EO, Teixeira C, da Silva LCC. Thoracic surgery: risk factors for postoperative complications of lung resection. Rev Assoc Med Bras (1992) 2011; 57:292-8. [DOI: 10.1590/s0104-42302011000300011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2010] [Accepted: 03/17/2011] [Indexed: 11/22/2022] Open
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Fernandes EO, Teixeira C, da Silva LCC. Thoracic surgery: risk factors for postoperative complications of lung resection. Rev Assoc Med Bras (1992) 2011. [DOI: 10.1016/s0104-4230(11)70061-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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State-of-the-art radiological techniques improve the assessment of postoperative lung function in patients with non-small cell lung cancer. Eur J Radiol 2011; 77:97-104. [DOI: 10.1016/j.ejrad.2009.07.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2009] [Revised: 07/22/2009] [Accepted: 07/22/2009] [Indexed: 11/21/2022]
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Perentes JY, Erling CC, Ris HB, Corpataux JM, Magnusson L. A simple bypass technique for superior vena cava reconstruction☆. Interact Cardiovasc Thorac Surg 2011; 12:15-9. [DOI: 10.1510/icvts.2010.247205] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Radiotherapy for lung cancer in the elderly. Lung Cancer 2010; 68:129-36. [DOI: 10.1016/j.lungcan.2009.12.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Revised: 11/30/2009] [Accepted: 12/07/2009] [Indexed: 12/25/2022]
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Caglar M, Kara M, Aksoy T, Kiratli PO, Karabulut E, Dogan R. Is the predicted postoperative FEV1 estimated by planar lung perfusion scintigraphy accurate in patients undergoing pulmonary resection? Comparison of two processing methods. Ann Nucl Med 2010; 24:447-53. [DOI: 10.1007/s12149-010-0378-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Accepted: 03/17/2010] [Indexed: 10/19/2022]
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Campione A, Terzi A, Bobbio M, Rosso GL, Scardovi AB, Feola M. Oxygen Pulse as a Predictor of Cardiopulmonary Events in Lung Resection. Asian Cardiovasc Thorac Ann 2010; 18:147-52. [DOI: 10.1177/0218492310361792] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Traditional algorithms suggest a stepwise approach to the functional evaluation of candidates for lung resection. A cardiopulmonary exercise test is incorporated as a supplementary test for patients with borderline pulmonary predicted values, and sometimes as a first screening test for cardiac risk evaluation. To assess the predictive weight of exercise tests in noncardiac thoracic surgery, we retrospectively analyzed 99 patients (80 males) aged 67.8 ± 8.1 years who underwent lung resection after a cardiopulmonary exercise test. During basal spirometry, the mean predicted forced expiratory volume in the first second was 69.9% ± 18.6%, and predicted carbon monoxide diffusing capacity was 71.6% ± 20.5%. Peak oxygen consumption was 11.1 ± 3.2 mL·kg−1·min−1, oxygen pulse was 9 ± 2.8 mL·beat−1, and minute ventilation/CO2 output was 45.2 ± 7.7. Mean hospital stay was 10.4 days, and intensive care unit stay was 0.3 days. Postoperative complications occurred in 20 (20%) patients. On multivariate analysis, body mass index, a high level of exercise achieved during the cardiopulmonary exercise test, lower heart rate at peak exercise, and oxygen pulse correlated significantly with better postoperative outcome. Cardiopulmonary exercise tests are helpful for stratifying patients undergoing thoracic surgery. Perioperative complications seem to be strongly related to left ventricular function and physical performance.
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Affiliation(s)
| | | | - Marco Bobbio
- Department of Cardiovascular Diseases Cuneo Hospital, Cuneo, Italy
| | - Gian Luca Rosso
- Department of Cardiovascular Diseases Cuneo Hospital, Cuneo, Italy
| | | | - Mauro Feola
- Department of Cardiovascular Diseases Cuneo Hospital, Cuneo, Italy
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Benzo RP, Sciurba FC. Oxygen consumption, shuttle walking test and the evaluation of lung resection. ACTA ACUST UNITED AC 2009; 80:19-23. [PMID: 19672050 DOI: 10.1159/000235543] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2009] [Accepted: 06/04/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND Assessment of peak oxygen uptake (VO(2)) is recommended in the evaluation of patients with borderline pulmonary function as VO(2) is the strongest independent predictor of postoperative pulmonary complications. However, the measurement of VO(2) requires expensive equipment not available in many medical facilities. The shuttle walking test (SWT) has been proposed to be used as a screening tool prior to performing a cardiopulmonary exercise test. Although an association exists between SWT distance and VO(2), only one small study directly measured VO(2) during the SWT. OBJECTIVES The aim of this study was to further validate the VO(2)-SWT association by directly measuring VO(2) during SWT in a larger cohort of patients with stable chronic obstructive pulmonary disease (COPD). METHODS Fifty stable COPD patients with mild/severe disease were studied. Each patient performed an SWT while wearing a validated portable metabolic monitor. RESULTS Mean VO(2) (ml/kg/min) measured after each finalized minute of the SWT was (95% confidence interval): 6 (5-7), 9 (8-10), 11 (10-12), 13 (11-14), 15 (14-16), 18 (16-20) and 21 (18-26) for minutes 1-7, respectively. Patients that completed the British Thoracic Society-recommended 25 shuttles (5 min or 250 m) in the SWT had a mean VO(2) of 15 (14-16). The positive predictive value for walking 25 shuttles (predicting a VO(2) of >or=15ml/kg/min) was 90% and the negative predictive value was 90%. CONCLUSIONS Our findings validate the association between VO(2) and SWT distance and facilitate the interpretation of the test in general practice, particularly when deciding the candidacy of a patient for surgical resection.
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Affiliation(s)
- Roberto P Benzo
- Divisions of Pulmonary and Critical Care Medicine at Mayo Clinic, Rochester, MN 55905, USA.
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Jaklitsch M, Billmeier S. Preoperative Evaluation and Risk Assessment for Elderly Thoracic Surgery Patients. Thorac Surg Clin 2009; 19:301-12. [DOI: 10.1016/j.thorsurg.2009.07.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Melloul E, Egger B, Krueger T, Cheng C, Mithieux F, Ruffieux C, Magnusson L, Ris HB. Mortality, complications and loss of pulmonary function after pneumonectomy vs. sleeve lobectomy in patients younger and older than 70 years. Interact Cardiovasc Thorac Surg 2008; 7:986-9. [DOI: 10.1510/icvts.2008.182279] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Long-term respiratory functional results after pneumonectomy. Eur J Cardiothorac Surg 2008; 34:164-8. [DOI: 10.1016/j.ejcts.2008.03.064] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2007] [Revised: 03/10/2008] [Accepted: 03/31/2008] [Indexed: 11/17/2022] Open
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Abstract
Preoperative evaluation before lung resection has been frequently addressed in modern medical literature. Actual or predicted pulmonary volumes are considered relevant to predict the risk of surgery. Nevertheless, ppoFEV1 underestimates the real functional loss in the immediate postoperative period when most of the complications occur. Not all patients, however, have comparable functional changes after lobectomy. Minimal impairment or even improvements have been demonstrated in COPD cases after lobectomy. Efforts should be directed to an accurate prediction of the immediate postoperative pulmonary volumes for a better evaluation of high-risk patients caused by respiratory impairment. Future developments are needed on the role of measuring preoperative DLCO and how to evaluate a patient's general cardiorespiratory status. Evidence underlines the relevance of routine evaluation of preoperative DLCO at rest or, better, during exercise for a thorough assessment of patient's capability to adapt to a stressful situation (Fig. 3). Only by improving knowledge about the general condition of the patient, can one assess the physiologic response to surgery. Widespread use of sophisticated or simple exercise tests and measurements or daily activity using motion detectors can identify high-risk patients with otherwise acceptable pulmonary volumes. Another suggested investigation issue is to develop different relevant outcome parameters, not only from the surgeon's point of view but also from the patient's perspective, such as postoperative QOL-related variables or delayed outcomes. Finally, multidisciplinary investigation teams, including experts in mathematical modeling, are essential to improve the quality and validity of the developed models. Although knowledge about perioperative physiologic changes has increased, clinicians are still far from finding a way to put all this knowledge down and make it applicable for an individual patient. Multicentric cooperation and evaluation of large prospectively recorded databases are essential to develop evidence-based clinical guidelines on preoperative evaluation.
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Koegelenberg CFN, Diacon AH, Irani S, Bolliger CT. Stair climbing in the functional assessment of lung resection candidates. Respiration 2008; 75:374-9. [PMID: 18272936 DOI: 10.1159/000116873] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2007] [Accepted: 11/27/2007] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Algorithms for the pre-operative evaluation of lung resection candidates with impaired lung function invariably include maximum oxygen uptake (VO(2)MAX) as a critical parameter of functional reserves, with a VO(2)MAX >or=20 ml/kg/min generally considered sufficient for pneumonectomy. Stair climbing is a low-cost alternative to assess exercise capacity. OBJECTIVES As stair climbing is not standardised, we aimed to compare the altitude reached and the speed of ascent with VO(2)MAX measured by cycle ergometry. METHODS We prospectively enrolled 44 pulmonary resection candidates (mean age: 47.6 +/- 12.5 years) with an FEV(1) <80%. Patients were asked to climb as high and as fast as they could, to a maximum elevation of 20 m. The altitude reached and the average speed of ascent were compared to VO(2)MAX. RESULTS Forty-three patients reached a 20-metre elevation. Thirteen of them, as well as the patient who did not reach this height, had a VO(2)MAX <20 ml/kg/min. There was a linear correlation between speed of ascent and VO(2)MAX/kg (R(2) = 0.67), but not between altitude and VO(2)MAX/kg. All 24 patients with a speed >or=15 m/min had a VO(2)MAX >or=20 ml/kg/min. Thirty-nine of 40 patients with a speed >or=12 m/min had a VO(2)MAX >or=15 ml/kg/min. CONCLUSIONS The average speed of ascent during stair climbing was an accurate semiquantitative predictor of VO(2)MAX/kg, whereas altitude was not. We were able to identify potential cut-off values for lobectomy or pneumonectomy. Pending validation with clinical endpoints, stair climbing may replace formal exercise testing at much lower costs in a large proportion of lung resection candidates.
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