PREOPERATIVE PULMONARY FUNCTION AS A PREDICTOR OF RESPIRATORY COMPLICATIONS AND MORTALITY IN PATIENTS UNDERGOING LUNG CANCER RESECTION

［Original Article］

PREOPERATIVE PULMONARY FUNCTION AS A PREDICTOR
OF RESPIRATORY COMPLICATIONS AND MORTALITY IN
PATIENTS UNDERGOING LUNG CANCER RESECTION

KOICHI FUJIU¹⁾, RYUZO KANNO¹⁾, HIROYUKI SUZUKI¹⁾,
YUTAKA SHIO¹⁾, MITSUNORI HIGUCHI¹⁾, JUN OHSUGI¹⁾,
AKIO OISHI²⁾ and MITSUKAZU GOTOH¹⁾

¹⁾Department of Surgery I, Fukushima Medical University School of Medicine, Fukushima
²⁾Department of Surgery, Fukushima Red Cross Hospital, Fukushima

(Received April 1, 2003, accepted June 12, 2003)

Abstract: Objective : We evaluated preoperative pulmonary function as a predictor of respiratory complications and mortality in patients undergoing lung cancer resection to confirm the guideline of the British Thoracic Society: lung cancer surgery in patients with predictive postoperative FEV_1.0 (%FEV_1.0ppo)>40% and predictive postoperative diffusion capacity for carbon monoxide (%DL_coppo)>40% can be carried out with average risk.
　　Methods : We retrospectively studied 356 consecutive patients who underwent pulmonary resection at our Department from January 1992 to December 2001.　Preoperative pulmonary function tests included vital capacity (VC), %VC, forced expiratory volume in one second (FEV_1.0), FEV_1.0%, diffusion capacity for carbon monoxide (DL_co), predictive postoperative FEV_1.0 (FEV_1.0ppo), postoperative respiratory function expressed as a percentage of the predicted normal value (%FEV_1.0ppo, %DL_coppo).　Postoperative complications were divided into 2 groups: respiratory complications (pneumonia, atelectasis, etc) and other complications (bronchopleural fistula, prolonged air leak, arrhythmia, etc).
　　Results : Postoperative deaths occurred in 14 (3.9%) patients.　Postoperative respiratory complications developed in 27 (7.6%) patients.　Pneumonectomy (p<0.001), preoperative chemotherapy (p<0.01) and advanced stage (p<0.05) were identified as risk factors of postoperative deaths.
　　Patients undergoing lobectomy with FEV_1.0≧1,500 ml did not die of respiratory complications.　Patients undergoing pneumonectomy with FEV_1.0ppo≧800 ml/m² did not die of respiratory complications.　Patients undergoing pneumonectomy with %FEV_1.0ppo<40% and %DL_coppo<40% did not survive.　Five of the 7 patients who died of respiratory complications were treated with preoperative chemotherapy.　The values of their %DL_coppo were all less than 40%.　By multivariate analysis, %FEV_1.0ppo was significant independent factor associated postoperative death.
　　Conclusions : We conclude that the guideline is useful for the selection for surgery of lung cancer patients.　If preoperative chemotherapy is performed, the measurement of %DL_co is recommended before surgery.

Key words: lung cancer, lung resection, pulmonary function, respiratory complication, mortality

藤生浩一，管野隆三，鈴木弘行，塩　　豊，樋口光徳，大杉　純，大石明雄，後藤満一

Correspondence to: Koichi Fujiu, Department of Surgery I, Fukushima Medical University School of Medicine, Fukushima City, Fukushima 960-1295, Japan.
E-mail: kfujiu@fmu.ac.jp