Quantitative computed tomography versus spirometry in predicting air leak duration after major lung resection for cancer.
BACKGROUND
Emphysema is a well-known risk factor for developing air leak or persistent air leak after pulmonary resection. Although quantitative computed tomography (CT) and spirometry are used to diagnose emphysema, it remains controversial whether these tests are predictive of the duration of postoperative air leak.


METHODS
Sixty-two consecutive patients who were scheduled to undergo major lung resection for cancer were enrolled in this prospective study to define the best predictor of postoperative air leak duration. Preoperative factors analyzed included spirometric variables and area of emphysema (proportion of the low-attenuation area) that was quantified in a three-dimensional CT lung model. Chest tubes were removed the day after disappearance of the air leak, regardless of pleural drainage. Univariate and multivariate proportional hazards analyses were used to determine the influence of preoperative factors on chest tube time (air leak duration).


RESULTS
By univariate analysis, site of resection (upper, lower), forced expiratory volume in 1 second, predicted postoperative forced expiratory volume in 1 second, and area of emphysema (< 1%, 1% to 10%, > 10%) were significant predictors of air leak duration. By multivariate analysis, site of resection and area of emphysema were the best independent determinants of air leak duration. The results were similar for patients with a smoking history (n = 40), but neither forced expiratory volume in 1 second nor predicted postoperative forced expiratory volume in 1 second were predictive of air leak duration.


CONCLUSIONS
Quantitative CT is superior to spirometry in predicting air leak duration after major lung resection for cancer. Quantitative CT may aid in the identification of patients, particularly among those with a smoking history, requiring additional preventive procedures against air leak.
Ueda
Kazuhiro
K
First Department of Surgery, Yamaguchi University School of Medicine, Ube Yamaguchi, Japan. kaueda@c-able.ne.jp
Kaneda
Yoshikazu
Y
Sudo
Manabu
M
Mitsutaka
Jinbo
J
Li
Tao-Sheng
TS
Suga
Kazuyoshi
K
Tanaka
Nobuyuki
N
Hamano
Kimikazu
K
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis*; D011656:Pulmonary Emphysema / Q000000981:diagnostic imaging / Q000209:etiology*; D013147:Spirometry; D014057:Tomography, X-Ray Computed