Lung scanning and exercise testing for the prediction of postoperative performance in lung resection candidates at increased risk for complications.
OBJECTIVE
To analyze the value of preoperative lung scanning and exercise testing for the prediction of postoperative complications and of the short- as well as long-term performance in lung resection candidates at increased risk for complications.


METHODS
Prospective clinical trial.


METHODS
Clinical pulmonary function laboratory in a university teaching hospital.


METHODS
Twenty-five (mean age, 63 years; 17 men) of 84 consecutive lung resection candidates were considered at increased risk for postoperative complications due to impaired pulmonary function (FEV1 < 2 L or diffusion of carbon monoxide [DCO] < 50% predicted, or FEV1 and DCO < or = 80% predicted combined with New York Heart Association dyspnea index > or = 2).


METHODS
Candidates underwent radionuclide ventilation/perfusion scans and exercise testing to predict postoperative (= ppo) values for FEV1, DCO, and maximal O2 uptake (VO2max). They all underwent thoracotomy for neoplastic lesions; 7 had pneumonectomies, 18 lobectomies. Six patients had postoperative complications (within 30 days), of whom three died. Three and 6 months postoperatively, pulmonary function tests and VO2max were repeated.


RESULTS
In the 22 survivors, the observed values were then compared with the predicted values. At 3 months, there were excellent correlations (absolute/predicted values): for FEV1 r = 0.78 and 0.81; for DCO, r = 0.77 and 0.74; and for VO2max, r = 0.71 and 0.83. The means of FEV1 and VO2max did not differ from the predicted values, whereas the predicted DCO was lower than the observed value (mL/min/mm Hg: 15.1 vs 17.9; percent predicted: 59.6 vs 70.9) (p < 0.05). At 6 months, correlations remained very good for FEV1 (r = 0.81 and 0.84) and for DCO (r = 0.76 and 0.74), but had decreased for VO2max to 0.56 and 0.65, respectively. All means were higher than predicted (p < 0.05) owing to recovery in the lobectomy group. Patients with postoperative complications (group B) had a lower preoperative VO2max in percent predicted (62.8 +/- 7.5% vs 84.6 +/- 19.7%) (p < 0.01) and also a lower VO2max-ppo (10.6 +/- 3.6 vs 14.8 +/- 3.5 mL/kg/min and 44.3 +/- 13.5 vs 68.0 +/- 20.7% predicted) (p < 0.05) than patients without complications (group A). A VO2max-ppo < 10 mL/kg/min was associated with a 100% mortality. Although FEV1-ppo and DCO-ppo were lower in group B, the difference did not reach significance.


CONCLUSIONS
Radionuclide-based calculations of postoperative VO2max are predictive of operative morbidity and mortality: a VO2max-ppo of < 10 mL/kg/min may indicate inoperability. Further, short-term postoperative performance is accurately predicted by FEV1-ppo and VO2max-ppo, but long-term function is underestimated after lobectomy.
Bolliger
C T
CT
Department of Internal Medicine, University Hospital, Basel, Switzerland.
Wyser
C
C
Roser
H
H
Solèr
M
M
Perruchoud
A P
AP
D000368:Aged; D005080:Exercise Test / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008175:Lung Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000401:mortality / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000175:diagnosis* / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D011877:Radionuclide Imaging; D012129:Respiratory Function Tests / Q000706:statistics & numerical data; D012307:Risk Factors; D013668:Technetium Tc 99m Aggregated Albumin; D013997:Time Factors
D013668:Technetium Tc 99m Aggregated Albumin