Original article
General thoracic
Operative Mortality and Respiratory Complications After Lung Resection for Cancer: Impact of Chronic Obstructive Pulmonary Disease and Time Trends

https://doi.org/10.1016/j.athoracsur.2005.11.048Get rights and content

Background

Smoking is a common risk factor for chronic obstructive pulmonary disease (COPD), cardiovascular disease, and lung cancer. In this observational study, we examined the impact of COPD severity and time-related changes in early outcome after lung cancer resection.

Methods

Over a 15-year period, we analyzed an institutional registry including all consecutive patients undergoing surgery for lung cancer. Using the receiver-operating characteristic (ROC) curve, we analyzed the relationship between forced expiratory volume in 1 second (FEV1) and postoperative mortality and respiratory morbidity. Multiple regression analysis has also been applied to identify other risk factors.

Results

A preoperative FEV1 less than 60% was a strong predictor for respiratory complications (odds ratio [OR] = 2.7, confidence interval [CI]: 1.3 to 6.6) and 30-day mortality (OR = 1.9, CI: 1.2 to 3.9), whereas thoracic epidural analgesia was associated with lower mortality (OR = 0.4; CI: 0.2 to 0.8) and respiratory complications (OR = 0.6; CI: 0.3 to 0.9). Mortality was also related to age greater than 70 years, the presence of at least three cardiovascular risk factors, and pneumonectomy. From the period 1990 to 1994, to 2000 to 2004, we observed significant reductions in perioperative mortality (3.7% versus 2.4%) and in the incidence of respiratory complications (18.7% versus 15.2%,) that was associated with a higher rate of lesser resection (from 11% to 17%,p< 0.05) and increasing use of thoracic epidural analgesia (from 65% to 88%, p< 0.05).

Conclusions

Preoperative FEV1less than 60% is a main predictor of perioperative mortality and respiratory morbidity. Over the last 5-year period, diagnosis of earlier pathologic cancer stages resulting in lesser pulmonary resection as well as provision of continuous thoracic epidural analgesia have contributed to improved surgical outcome.

Section snippets

Patient Management

From January 1, 1990, to December 30, 2004, 1,239 consecutive thoracotomies for lung cancer (reinterventions, n = 31) were performed in two affiliated medical institutions: an academic center (Hôpitaux Universitaires de Genève [HUG]) and a regional hospital (Centre Valaisan de Pneumologie [CVP]) that covered an area with approximately 680,000 inhabitants.

Preoperatively, patients with borderline spirometric results (FEV1 lower than 60% of predicted), impaired exercise tolerance or cardiac risk

Results

From 1993 through 2004, completed data were obtained in 1,222 cases that were distributed in three groups: normal or mild impairment in pulmonary function tests (FEV1≥70%: n = 728, 60%), moderate COPD (FEV150% to 70%: n = 397, 32%), and severe COPD (FEV1<50%: n = 97, 8%).

Comment

Over a 15-year period, retrospective analysis of 1,222 patients operated on for lung cancer demonstrated that (1) moderate-to-severe COPD was documented in 40% of surgical candidates, (2) preoperative FEV1below a threshold of 60% carried a twofold to threefold increased risk for operative mortality and respiratory complications whereas TEA was a predictor of better short-term outcome, and (4) over the last 5 years, a higher proportion of lesser resection due to diagnosis of earlier pathologic

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