Size-capacity mismatch in the lung: A novel predictor for complications after lung cancer surgery

• Published in: The Journal of surgical research Vol. 209; pp. 131 - 138
• Main Authors: Murakami, Junichi, MD, Ueda, Kazuhiro, MD, Hayashi, Masataro, MD, Kobayashi, Taiga, MD, Kunihiro, Yoshie, MD, Hamano, Kimikazu, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2017
• Subjects: Aged; Aged, 80 and over; Cardiopulmonary complication; Computed tomography; Female; Heart Diseases - epidemiology; Humans; Japan - epidemiology; Lung - diagnostic imaging; Lung - pathology; Lung cancer; Lung Diseases - epidemiology; Lung Neoplasms - surgery; Male; Middle Aged; Organ Size; Postoperative Complications - epidemiology; Pulmonary function; Respiratory Function Tests; Retrospective Studies; Risk analysis; ROC Curve; Surgery; Thoracic Surgery, Video-Assisted; Thoracoscopic surgery; Tomography, X-Ray Computed; thoracoscopic surgery; lung cancer; computed tomography; pulmonary function; cardiopulmonary complication; risk analysis; Pulmonary function; Computed tomography; Risk analysis; Cardiopulmonary complication; Lung cancer; Thoracoscopic surgery
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2016.08.051

Abstract Background The aim of the present study was to make a combined pulmonary functional and anatomical assessment using spirometry and computed tomography in order to clarify the best predictor for cardiopulmonary complications after thoracoscopic major lung resection for cancer. Methods We retrospectively reviewed our prospective database of 304 patients undergoing thoracoscopic major lung resection for cancer. The total lung volume (TLV) was measured preoperatively using deep-inspiratory computed tomography by summing the voxels representing -600 to -1024 Hounsfield units. Forced vital capacity (FVC) was measured by spirometry. FVC/TLV was used to diagnose a lung size-function mismatch. We compared among FVC/TLV, conventional spirometric parameters, and the risk of postoperative cardiopulmonary complications. Results Postoperative cardiopulmonary complications developed in 25 of 304 (8.2%) patients. There were no cases of operative mortality. A stepwise logistic regression analysis revealed that a history of smoking and low FVC/TLV were independent risk factors for postoperative cardiopulmonary complications in various preoperative measurements. According to a receiver operating characteristic analysis, FVC/TLV was the only variable that was statistically useful for predicting complications (area under the curve > 0.7). Conclusions Lung size-function mismatch was identified as the best predictor for cardiopulmonary complications after major lung resection for cancer among various spirometry- and computed tomography-derived parameters. The usefulness of this parameter in screening for patients who are at risk of complications should be validated by a multicenter, large-scale study because it can be obtained through routine preoperative work.