Fall in diffusing capacity associated with induction therapy for lung cancer: a predictor of postoperative complication?
BACKGROUND
Pulmonary resection after induction therapy is associated with high rates of pulmonary morbidity and mortality. However, the impact of induction therapy on the pulmonary toxicity and associated pulmonary complications has not been fully investigated in the setting of lung cancer surgery.


METHODS
We assessed the 66 consecutive patients who underwent a pulmonary resection after induction therapy, 48 of whom received chemoradiotherapy and 18, chemotherapy alone. Results of pulmonary function before and after induction therapy were compared, and logistic regression analyses utilized to explore the risk factors of pulmonary morbidity.


RESULTS
After induction therapy, forced expiratory volume in 1 second (FEV1) was increased significantly (from 2.28 +/- 0.61 L to 2.40 +/- 0.62 L; p < 0.05); however, percent vital capacity (%VC) and FEV1/FVC did not change significantly. The diffusing capacity of lung for carbon monoxide (D(LCO)) was decreased significantly by 21% (from 90.3% +/- 18.3% to 71.1% +/- 12.5%; p < 0.0005). Patients with respiratory complication showed lower predicted postoperative %FEV1 (49.5% +/- 11.1% versus 57.2% +/- 14.2%; p = 0.031) and predicted postoperative %Dlco (41.9% +/- 8.0% versus 55.4% +/- 10.1%; p < 0.0001) results than those without complications. Univariate and multivariate analyses revealed that predicted postoperative %D(LCO) alone was an independent factor to predict postoperative pulmonary morbidity.


CONCLUSIONS
For patients who undergo a pulmonary resection after induction therapy, predicted postoperative %D(LCO) is more important to predict pulmonary morbidity rather than static pulmonary function (predicted postoperative %VC or %FEV1). The decrease in D(LCO) is thought to reflect a limited gas exchange reserve, caused by the potential toxicity of chemotherapy or chemoradiotherapy. We believe that the impact of diffusion limitation after induction therapy should to be emphasized to decrease the pulmonary morbidity.
Takeda
Shin-ichi
S
Department of General Thoracic Surgery, Toneyama National Hospital, Toyonaka City, Osaka, Japan. stakeda@toneyama.hosp.go.jp
Funakoshi
Yasunobu
Y
Kadota
Yoshihisa
Y
Koma
Masaru
M
Maeda
Hajime
H
Kawamura
Satoko
S
Matsubara
Yoko
Y
D000230:Adenocarcinoma / Q000188:drug therapy / Q000503:physiopathology / Q000532:radiotherapy / Q000601:surgery; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002248:Carbon Monoxide / Q000032:analysis; D018287:Carcinoma, Large Cell / Q000188:drug therapy / Q000503:physiopathology / Q000532:radiotherapy / Q000601:surgery; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000503:physiopathology* / Q000532:radiotherapy / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000503:physiopathology / Q000532:radiotherapy / Q000601:surgery; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D016724:Empyema, Pleural / Q000209:etiology; D005260:Female; D005541:Forced Expiratory Volume; D005544:Forecasting; D006801:Humans; D000860:Hypoxia / Q000209:etiology; D008175:Lung Neoplasms / Q000188:drug therapy / Q000503:physiopathology* / Q000532:radiotherapy / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D011013:Pneumonectomy; D011014:Pneumonia / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D011237:Predictive Value of Tests; D001261:Pulmonary Atelectasis / Q000209:etiology; D011653:Pulmonary Diffusing Capacity; D011655:Pulmonary Embolism / Q000209:etiology / Q000401:mortality; D011659:Pulmonary Gas Exchange; D011878:Radiotherapy / Q000009:adverse effects; D012074:Remission Induction; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000401:mortality; D012131:Respiratory Insufficiency / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D014747:Vinblastine / Q000008:administration & dosage / Q000031:analogs & derivatives; D014751:Vindesine / Q000008:administration & dosage; D000077235:Vinorelbine; D014797:Vital Capacity
D016685:Mitomycin; D014747:Vinblastine; D002248:Carbon Monoxide; D002945:Cisplatin; D000077235:Vinorelbine; D014751:Vindesine