title: Size-capacity mismatch in the lung: a novel predictor for complications after lung cancer surgery.
abstract: The aim of the present study was to make a combined pulmonary functional and anatomical assessment using spirometry and computed tomography (CT) to clarify the best predictor for cardiopulmonary complications after thoracoscopic major lung resection for cancer.
  
  
  
  We retrospectively reviewed our prospective database of 304 patients undergoing thoracoscopic major lung resection for cancer. The total lung volume (TLV) was measured preoperatively using deep-inspiratory CT by summing the voxels representing -600 to -1024 Hounsfield units. Forced vital capacity (FVC) was measured by spirometry. FVC/TLV was used to diagnose a lung size-function mismatch. We compared among FVC/TLV, conventional spirometric parameters, and the risk of postoperative cardiopulmonary complications.
  
  
  
  Postoperative cardiopulmonary complications developed in 25 of 304 patients (8.2%). There were no cases of operative mortality. A stepwise logistic regression analysis revealed that a history of smoking and low FVC/TLV were independent risk factors for postoperative cardiopulmonary complications in various preoperative measurements. According to a receiver-operating characteristic analysis, FVC/TLV was the only variable that was statistically useful for predicting complications (area under the receiver-operating characteristic curve > 0.7).
  
  
  
  Lung size-function mismatch was identified as the best predictor for cardiopulmonary complications after major lung resection for cancer among various spirometry- and CT-derived parameters. The usefulness of this parameter in screening for patients who are at risk of complications should be validated by a multicenter, large-scale study because it can be obtained through routine preoperative work.
authors.affiliation: Division of Chest Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Murakami
authors.affiliation: Division of Chest Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan. Electronic address: kaueda@c-able.ne.jp.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Ueda
authors.affiliation: Division of Chest Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan.
authors.forename: Masataro
authors.initials: M
authors.lastname: Hayashi
authors.affiliation: Division of Radiology, Department of Radiopathology and Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan.
authors.forename: Taiga
authors.initials: T
authors.lastname: Kobayashi
authors.affiliation: Division of Radiology, Department of Radiopathology and Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan.
authors.forename: Yoshie
authors.initials: Y
authors.lastname: Kunihiro
authors.affiliation: Division of Chest Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan.
authors.forename: Kimikazu
authors.initials: K
authors.lastname: Hamano
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology; D008171:Lung Diseases / Q000453:epidemiology*; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011183:Postoperative Complications / Q000453:epidemiology*; D012372:ROC Curve; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted; D014057:Tomography, X-Ray Computed
keywords: Cardiopulmonary complication; Computed tomography; Lung cancer; Pulmonary function; Risk analysis; Thoracoscopic surgery