Top

Published in:

01-03-2023 | Lung Cancer | Original Article

Predictive factors inhibiting recovery of the respiratory function after anatomical pulmonary resection

Authors: Hiroyasu Ueno, Kazuya Takamochi, Shunki Hirayama, Mariko Fukui, Aritoshi Hattori, Takeshi Matsunaga, Takamitsu Banno, Kenji Suzuki

Published in: Surgery Today | Issue 9/2023

Abstract

Purpose

Some patients have worse actual observed postoperative (apo) respiratory function values than predicted postoperative (ppo) values. The present study therefore clarified the predictive factors that hinder the recovery of the postoperative respiratory function.

Methods

This study enrolled 255 patients who underwent anatomical pulmonary resection for lung cancer. A pulmonary function test (PFT) was carried out before surgery and at one, three, and six months after surgery. In each surgical procedures, the forced expiratory volume in 1 s (FEV1) ratio was calculated as the apo value divided by the ppo value. In addition, we investigated the predictive factors that inhibited postoperative respiratory function improvement in patients with an FEV1 ratio < 1.0 at 6 months after surgery.

Results

The FEV1 ratio gradually improved over time in all surgical procedures. However, 49 of 196 patients who underwent a PFT at 6 months after surgery had an FEV1 ratio < 1.0. In a multivariate analysis, right side, upper lobe, segmentectomy and pleurodesis for prolonged air leakage were independent significant predictors of a decreased FEV1 ratio (p = 0.003, 0.006, 0.001, and 0.009, respectively).

Conclusion

Pleurodesis was the only controllable factor that might help preserve the postoperative respiratory function. Thus, the intraoperative management of air leakage is important.

Available only for authorised users

Sarna L, Evangelista L, Tashkin D, Padilla G, Holmes C, Brecht ML, et al. Impact of respiratory symptoms and pulmonary function on quality of life of long-term survivors of non-small cell lung cancer. Chest. 2004;125(2):439–45.CrossRefPubMed

Pierce RJ, Copland JM, Sharpe K, Barter CE. Preoperative risk evaluation for lung cancer resection: predicted postoperative product as a predictor of surgical mortality. Am J Respir Crit Care Med. 1994;150:947–55.CrossRefPubMed

Miyazaki T, Callister MEJ, Franks K, Dinesh P, Nagayasu T, Brunelli A. Minute ventilation-to-carbon dioxide slope is associated with postoperative survival after anatomical lung resection. Lung Cancer. 2018;125:218–22.CrossRefPubMed

Kearney DJ, Lee TH, Reilly JJ, DeCamp MM, Sugarbaker DJ. Assessment of operative risk in patients undergoing lung resection. Importance of predicted pulmonary function. Chest. 1994;105:753–9.CrossRefPubMed

Wang JS. Relationship of carbon monoxide pulmonary diffusing capacity to postoperative cardiopulmonary complications in patients undergoing pneumonectomy. Kaohsiung J Med Sci. 2003;19:437–46.CrossRefPubMed

Brunelli A, Charloux A, Bolliger CT, Rocco G, Sculier JP, Varela G, et al. ERS/ESTS clinical guidelines on fitness for radical therapy in lung cancer patients (surgery and chemo-radiotherapy). Eur Respir J. 2009;34:17–41.CrossRefPubMed

Korst RJ, Ginsberg RJ, Ailawadi M, Bains MS, Downey RJ Jr, Rusch VW, et al. Lobectomy improves ventilatory function in selected patients with severe COPD. Ann Thorac Surg. 1998;66:898–902.CrossRefPubMed

Ueda K, Murakami J, Sano F, Hayashi M, Kobayashi T, Kunihiro Y, et al. Assessment of volume reduction effect after lung lobectomy for cancer. J Surg Res. 2015;197:176–82.CrossRefPubMed

Brunelli A, Refai MA, Salati M, Sabbatini A, Morgan-Hughes NJ, Rocco G. Carbon monoxide lung diffusion capacity improves risk stratification in patients without airflow limitation: evidence for systematic measurement before lung resection. Eur J Cardiothorac Surg. 2006;29:567–70.CrossRefPubMed

10.

Ferguson MK, Vigneswaran WT. Diffusing capacity predicts morbidity after lung resection in patients without obstructive lung disease. Ann Thorac Surg. 2008;85:1158–64.CrossRefPubMed

11.

Yokoba M, Ichikawa T, Harada S, Naito M, Sato Y, Katagiri M. Postoperative pulmonary function changes according to the resected lobe: a 1-year follow-up study of lobectomized patients. J Thorac Dis. 2018;10(12):6891–902.CrossRefPubMedPubMedCentral

12.

Takamochi K, Imashimizu K, Fukui M, Maeyashiki T, Suzuki M, Ueda T, et al. Utility of objective chest tube management after pulmonary resection using a digital drainage system. Ann Thorac Surg. 2017;104:275–83.CrossRefPubMed

13.

Fukui M, Takamochi K, Suzuki K, Ando K, Matsunaga T, Hattori A, et al. Advantages and disadvantages of corticosteroid use for acute exacerbation of interstitial pneumonia after pulmonary resection. Gen Thorac Cardiovasc Surg. 2021;69:472–7.CrossRefPubMed

14.

Brunelli A, Refai M, Salati M, Xiume F, Sabbatini A. Predicted versus observed FEV1 and DLCO after major lung resection: a prospective evaluation at different postoperative periods. Ann Thorac Surg. 2007;83:1134–9.CrossRefPubMed

15.

Nomori H, Shiraishi A, Cong Y, Sugimura H, Mishima S. Differences in postoperative changes in pulmonary functions following segmentectomy compared with lobectomy. Eur J Cardiothorac Surg. 2018;53:640–7.CrossRefPubMed

16.

Okada M, Koike T, Higashiyama M, Yamato Y, Kodama K, Tsubota N. Radical sublobar resection for small-sized non-small cell lung cancer: a multicenter study. J Thorac Cardiovasc Surg. 2006;132:769–75.CrossRefPubMed

17.

Ueda K, Tanaka T, Hayashi M, Li TS, Tanaka N, Hamano K. Computed tomography-defined functional lung volume after segmentectomy versus lobectomy. Eur J Cardiothorac Surg. 2010;37:1433–7.CrossRefPubMed

18.

Deng B, Cassivi SD, de Andrade M, Nichols FC, Trastek VF, Wang Y, et al. Clinical outcomes and changes in lung function after segmentectomy versus lobectomy for lung cancer cases. J Thorac Cardiovasc Surg. 2014;148:1186–92.CrossRefPubMedPubMedCentral

19.

Yoshimoto K, Nomori H, Mori T, Ohba Y, Shiraishi K, Tashiro K, et al. Postoperative change in pulmonary function of the ipsilateral preserved lung after segmentectomy versus lobectomy. Eur J Cardiothorac Surg. 2010;37:36–9.CrossRefPubMed

20.

Yamagishi H, Chen-Yoshikawa TF, Oguma T, Hirai T, Date H. Morphological and functional reserves of the right middle lobe: radiological analysis of changes after right lower lobectomy in healthy individuals. J Thorac Cardiovasc Surg. 2021;162:1417–23.CrossRefPubMed

21.

Irani B, Miller JE, Linberg E, Attar S. Use of radiopaque markings on middle lobe (or lingula) following upper resectional surgery. Ann Thorac Surg. 1968;5:1–7.CrossRefPubMed

22.

Maeyashiki T, Takamochi K, Matsunaga T, Oh S, Suzuki K. Negative impact of chemical pleurodesis on postoperative pulmonary function for managing prolonged air leakage after segmentectomy. Gen Thorac Cardiovasc Surg. 2021;69:707–15.CrossRefPubMed

Title: Predictive factors inhibiting recovery of the respiratory function after anatomical pulmonary resection
Authors: Hiroyasu Ueno
Kazuya Takamochi
Shunki Hirayama
Mariko Fukui
Aritoshi Hattori
Takeshi Matsunaga
Takamitsu Banno
Kenji Suzuki
Publication date: 01-03-2023
Publisher: Springer Nature Singapore
Keywords: Lung Cancer
Lung Cancer
Pleurodesis
Pneumonectomy
Lung Cancer
Published in: Surgery Today / Issue 9/2023
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI: https://doi.org/10.1007/s00595-023-02666-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Predictive factors inhibiting recovery of the respiratory function after anatomical pulmonary resection

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 9/2023

Long-term outcomes of upfront robotic rectal cancer surgery: a single-center, retrospective cohort study in Japan

Prognostic significance of the cachexia index in patients with stage I–III colorectal cancer who underwent laparoscopic surgery

Risk factors for small-bowel obstruction after colectomy for colorectal cancer: a retrospective study

Comparable efficacy and safety of COVID-19 vaccines for patients receiving tegafur–uracil as postoperative adjuvant chemotherapy

Perioperative outcomes of minimally invasive surgery for large malignant thymic epithelial tumors and for total thymectomy

Surgical management of appendicitis in patients with human immunodeficiency virus (HIV) positivity: a propensity score-matched analysis in a base hospital for HIV treatment in Japan