Prediction of functional reserves after lung resection: comparison between quantitative computed tomography, scintigraphy, and anatomy.
OBJECTIVE
We prospectively compared five techniques to estimate predicted postoperative function (ppo F) after lung resection: recently proposed quantitative CT scans (CT), perfusion scans (Q), and three anatomical formulae based on the number of segments (S), functional segments (FS), and subsegments (SS) to be removed.


METHODS
Four parameters were assessed: FEV(1), FVC, DL(CO) and VO(2max), measured preoperatively and 6 months postoperatively in 44 patients undergoing pulmonary resection, comparing their ppo value to the postoperatively measured value.


RESULTS
The correlations (r) obtained with the five methods were for CT: FEV(1) = 0.91, FVC = 0.86, DL(CO) = 0.84, VO(2max) = 0.77; for Q: 0.92, 0.90, 0.85, 0.85; for S: 0.88, 0.86, 0.84, 0.75; for FS: 0.88, 0.85, 0.85, 0.75, and for SS: 0.88, 0.86, 0.85, 0.75, respectively. The mean difference between ppo values and postoperatively measured values was smallest for Q estimates and largest for anatomical estimates using S. Stratification of the extent of resection into lobectomy (n = 30) + wedge resections (n = 4) versus pneumonectomy (n = 10) resulted in persistently high correlations for Q and CT estimates, whereas all anatomical correlations were lower after pneumonectomy.


CONCLUSIONS
We conclude that both Q- and CT-based predictions of postoperative cardiopulmonary function are useful irrespective of the extent of resection, but Q-based results were the most accurate. Anatomically based calculations of ppo F using FS or SS should be reserved for resections not exceeding one lobe.
Bolliger
Chris T
CT
Respiratory Division, Department of Internal Medicine, Institute of Nuclear Medicine, Department of Surgery, University Hospital, Basel, Switzerland. ctb@sun.ac.za
Gückel
Claudius
C
Engel
Hermann
H
Stöhr
Susanne
S
Wyser
Christoph P
CP
Schoetzau
Andreas
A
Habicht
James
J
Solèr
Markus
M
Tamm
Michael
M
Perruchoud
André P
AP
D000368:Aged; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D011013:Pneumonectomy; D011184:Postoperative Period; D011446:Prospective Studies; D011877:Radionuclide Imaging; D012129:Respiratory Function Tests; D013147:Spirometry; D014057:Tomography, X-Ray Computed; D014797:Vital Capacity