Physiologic assessment before video thoracoscopic resection for lung cancer in patients with abnormal pulmonary function.
BACKGROUND
Impaired respiratory function may prevent curative surgery for patients with non-small cell lung cancer (NSCLC). Video-assisted thoracoscopic surgery (VATS) reduces postoperative morbility-mortality and could change preoperative assessment practices and therapeutic decisions. We evaluated the relation between preoperative pulmonary function tests and the occurrence of postoperative complications after VATS pulmonary resection in patients with abnormal pulmonary function.


METHODS
We included 106 consecutive patients with ≤80% predicted value of presurgical expiratory volume in one second (FEV1) and/or diffusing capacity of carbon monoxide (DLCO) and who underwent VATS pulmonary resection for NSCLC from a prospective surgical database.


RESULTS
Patients (64±9.5 years) had lobectomy (n=91), segmentectomy (n=7), bilobectomy (n=4), or pneumonectomy (n=4). FEV1 and DLCO preoperative averages were 68%±21% and 60%±18%. Operative mortality was 1.89%. Only FEV1 was predictive of postoperative complications [odds ratio (OR), 0.96; 95% confidence interval (CI), 0.926-0.991, P=0.016], but there was no determinable threshold. Twenty-five patients underwent incremental exercise testing. Desaturations during exercise (OR, 0.462; 95% CI, 0.191-0.878, P=0.039) and heart rate (HR) response (OR, 0.953; 95% CI, 0.895-0.993, P=0.05) were associated with postoperative complications.


CONCLUSIONS
FEV1 but not DLCO was a significant predictor of pulmonary complications after VATS pulmonary resection despite a low rate of severe morbidity. Incremental exercise testing seems more discriminating. Further investigation is required in a larger patient population to change current pre-operative threshold in a new era of minimally invasive surgery.
1 Department of Pneumology and Unit of Respiratory Intensive Care, 2 Department of Respiratory and Sports Physiology, Rouen University Hospital, Rouen, France ; 3 SASU ThinkR, Caen, France ; 4 UPRES EA 3830 Experimental Surgery Laboratory, Institute for Research and Innovation in Biomedicine, Normandie University, Rouen, France ; 5 Department of General and Thoracic Surgery, Rouen University Hospital, Rouen, France.
Amira
A
Benattia
1 Department of Pneumology and Unit of Respiratory Intensive Care, 2 Department of Respiratory and Sports Physiology, Rouen University Hospital, Rouen, France ; 3 SASU ThinkR, Caen, France ; 4 UPRES EA 3830 Experimental Surgery Laboratory, Institute for Research and Innovation in Biomedicine, Normandie University, Rouen, France ; 5 Department of General and Thoracic Surgery, Rouen University Hospital, Rouen, France.
David
D
Debeaumont
1 Department of Pneumology and Unit of Respiratory Intensive Care, 2 Department of Respiratory and Sports Physiology, Rouen University Hospital, Rouen, France ; 3 SASU ThinkR, Caen, France ; 4 UPRES EA 3830 Experimental Surgery Laboratory, Institute for Research and Innovation in Biomedicine, Normandie University, Rouen, France ; 5 Department of General and Thoracic Surgery, Rouen University Hospital, Rouen, France.
Vincent
V
Guyader
1 Department of Pneumology and Unit of Respiratory Intensive Care, 2 Department of Respiratory and Sports Physiology, Rouen University Hospital, Rouen, France ; 3 SASU ThinkR, Caen, France ; 4 UPRES EA 3830 Experimental Surgery Laboratory, Institute for Research and Innovation in Biomedicine, Normandie University, Rouen, France ; 5 Department of General and Thoracic Surgery, Rouen University Hospital, Rouen, France.
Catherine
C
Tardif
1 Department of Pneumology and Unit of Respiratory Intensive Care, 2 Department of Respiratory and Sports Physiology, Rouen University Hospital, Rouen, France ; 3 SASU ThinkR, Caen, France ; 4 UPRES EA 3830 Experimental Surgery Laboratory, Institute for Research and Innovation in Biomedicine, Normandie University, Rouen, France ; 5 Department of General and Thoracic Surgery, Rouen University Hospital, Rouen, France.
Christophe
C
Peillon
1 Department of Pneumology and Unit of Respiratory Intensive Care, 2 Department of Respiratory and Sports Physiology, Rouen University Hospital, Rouen, France ; 3 SASU ThinkR, Caen, France ; 4 UPRES EA 3830 Experimental Surgery Laboratory, Institute for Research and Innovation in Biomedicine, Normandie University, Rouen, France ; 5 Department of General and Thoracic Surgery, Rouen University Hospital, Rouen, France.
Antoine
A
Cuvelier
1 Department of Pneumology and Unit of Respiratory Intensive Care, 2 Department of Respiratory and Sports Physiology, Rouen University Hospital, Rouen, France ; 3 SASU ThinkR, Caen, France ; 4 UPRES EA 3830 Experimental Surgery Laboratory, Institute for Research and Innovation in Biomedicine, Normandie University, Rouen, France ; 5 Department of General and Thoracic Surgery, Rouen University Hospital, Rouen, France.
Jean-Marc
JM
Baste
Lung cancer; exercise testing; preoperative assessment; pulmonary function testing; video-assisted thoracoscopic surgery (VATS)