Role of Quantitative CT in Predicting Hypoxemia and Complications After Lung Lobectomy for Cancer, With Special Reference to Area of Emphysema

• Published in: Chest Vol. 128; no. 5; pp. 3500 - 3506
• Main Authors: Ueda, Kazuhiro, Kaneda, Yoshikazu, Sudoh, Manabu, Mitsutaka, Jinbo, Tanaka, Nobuyuki, Suga, Kazuyoshi, Hamano, Kimikazu
• Format: Journal Article
• Language: English
• Published: Northbrook, IL Elsevier Inc 01.11.2005; American College of Chest Physicians
• Subjects: 3D = three dimensional; Aged; Biological and medical sciences; Cancer; Cardiology. Vascular system; complication; CPC = cardiopulmonary complication; Emphysema; Female; HU = Hounsfield units; Humans; hypoxemia; Hypoxia - etiology; LAA = extent of low-attenuation area; Logistic Models; low attenuation area; Lung diseases; Lung Neoplasms - surgery; Male; Medical sciences; Middle Aged; Oxygen - blood; Oxygen saturation; Patients; Pneumology; Pneumonectomy - adverse effects; postSao2= postoperative arterial oxygen saturation; ppoFEV1= predicted postoperative FEV1; ppoSao2= predicted postoperative arterial oxygen saturation; preSao2= preoperative arterial oxygen saturation; Proportional Hazards Models; Prospective Studies; Pulmonary Emphysema - diagnostic imaging; Pulmonary Emphysema - etiology; pulmonary resection; quantitative CT; Respiratory system : syndromes and miscellaneous diseases; Sao2= arterial oxygen saturation; Smoking; Spirometry; Thoracic surgery; Tomography, X-Ray Computed - methods; Tumors of the respiratory system and mediastinum; Variables; VC = vital capacity; hypoxemia; complication; preSao2= preoperative arterial oxygen saturation; pulmonary resection; postSao2= postoperative arterial oxygen saturation; quantitative CT; LAA = extent of low-attenuation area; CPC = cardiopulmonary complication; spirometry; HU = Hounsfield units; low attenuation area; ppoSao2= predicted postoperative arterial oxygen saturation; ppoFEV1= predicted postoperative FEV1; VC = vital capacity; 3D = three dimensional; Sao2= arterial oxygen saturation; Spirometry; Lung cancer; Cardiovascular disease; Lung function; Hypoxemia; Surgery; Bronchus disease; Attenuation; Complication; Obstructive pulmonary disease; Quantitative analysis; Lung disease; Oxygen; Radiodiagnosis; Respiratory disease; Reference; Exploration; Surgical resection; Area; Treatment; Low; Medical imagery; Computerized axial tomography; Emphysema; Lobectomy
• ISSN: 0012-3692; 1931-3543
• DOI: 10.1378/chest.128.5.3500

Study objectives: To determine the ability of quantitative CT, with special reference to area of emphysema, to predict early postoperative oxygenation capacity and outcome after lung lobectomy for cancer. Methods: Sixty-two consecutive patients scheduled to undergo lung lobectomy for cancer were enrolled in this study. The area of emphysema (< - 910 Hounsfield units) was measured on a three-dimensional CT lung model. Arterial oxygen saturation (Sao2) was calculated from Pao2measured 1 day before and 1 day after surgery with patients at rest breathing room air. A patient was considered to have recovered at the completion of a standardized management regimen. Results: Postoperative Sao2(postSao2) was predicted by the baseline value and the area of emphysema with the use of a regression equation. Ten of the 62 patients (16%) had postoperative cardiopulmonary complications (CPCs). The median time to postoperative recovery was 3 days (range, 1 to 17 days). Predicted postSao2and predicted postoperative FEV1were shown to be significant independent predictors of postoperative CPCs as well as postoperative recovery time. Conclusion: Determining the area of emphysema by quantitative CT is useful in predicting early postoperative oxygenation capacity. Predicted oxygenation capacity and predicted ventilatory capacity independently affect perioperative outcomes. Therefore, using quantitative CT in combination with spirometry may improve risk prediction in patients undergoing lung lobectomy for cancer. However, the role of quantitative CT in grading nonemphysematous lung diseases, such as interstitial lung diseases, must be investigated.