title: Performance of wider parenchymal lung resection than preoperatively planned in patients with low preoperative lung function performance undergoing video-assisted thoracic surgery major lung resection.
abstract: Pulmonary assessment before major lung resections is used to determine patient's operability. In marginal cases, extensive pulmonary assessment is additionally important under the fear of a more radical parenchymal removal. This study investigates the outcome of wider lung parenchymal resections in patients with low lung functional status undergoing video-assisted thoracic surgery (VATS) major lung resection.
  
  
  
  The medical records of patients who underwent VATS major lung resection for cancer, over a period of 5 years (August 2009-August 2014), were retrospectively reviewed. Patients with postoperative forced expiratory volume in first second (ppoFEV1) or postoperative diffusional capacity for carbon monoxide (ppoDLCO) <40% who underwent wider lung resection than preoperatively planned (Group A) were compared with patients with ppoFEV1 or ppoDLCO <40% who underwent the planned operation (Group B) and patients with ppoFEV1 and ppoDLCO >40% who underwent wider resection than preoperatively planned (Group C). Data analysed included demographics, past medical history, the surgery planned and performed, the reason for higher parenchymal resection, the clinical and pathological stage, the length of stay (LOS), the morbidity, the 30-day mortality and the survival.
  
  
  
  Overall, 73 patients were analysed (15 patients in Group A, 50 patients in Group B and 8 patients in Group C). The mean age was 68.5 years and 31.5% were males. The wider lung resection regarded 7 patients who underwent bilobectomy instead of lobectomy and 16 patients who underwent pneumonectomy instead of lobectomy. The main reason for higher resection was the wider invasion of the mass (21 patients). The age, gender and body mass index between three groups were similar, whereas ppoFEV1 and ppoDLCO were different (P < 0.001 and P < 0.001 respectively). Conversions, pulmonary morbidity and the 30-day mortality between groups were similar (P = 0.67, P = 0.88 and P = 0.33, respectively). LOS between groups was not different (P = 0.46). Survival rate between groups was also similar (log-rank, P = 0.79).
  
  
  
  Wider lung parenchymal resection than preoperatively anticipated may be performed, even in patients with low lung functional status, without increased adverse outcome when compared with patients with good lung function. This finding indicates that the preoperative risk stratification based on lung function tests is questionable.
authors: Department of Thoracic Surgery, St James's University Hospital, Leeds, UK vasileios@doctors.org.uk.
authors: Vasileios K
authors: VK
authors: Kouritas
authors: Department of Thoracic Surgery, St James's University Hospital, Leeds, UK.
authors: Emmanuel
authors: E
authors: Kefaloyannis
authors: Department of Thoracic Surgery, St James's University Hospital, Leeds, UK.
authors: Richard
authors: R
authors: Milton
authors: Department of Thoracic Surgery, St James's University Hospital, Leeds, UK.
authors: Nilanjan
authors: N
authors: Chaudhuri
authors: Department of Thoracic Surgery, St James's University Hospital, Leeds, UK.
authors: Konstantinos
authors: K
authors: Papagiannopoulos
authors: Department of Thoracic Surgery, St James's University Hospital, Leeds, UK.
authors: Alessandro
authors: A
authors: Brunelli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D007902:Length of Stay; D008175:Lung Neoplasms / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D012189:Retrospective Studies; D015996:Survival Rate; D020775:Thoracic Surgery, Video-Assisted
keywords: Lobectomy; Low pulmonary function test; Video-assisted thoracic surgery; Wider