Impact of compromised pulmonary function on major lung resection for non-small cell lung cancer： retrospective study of 127 cases

• Published in: Chinese medical journal 2012-10, Vol.125 (19), p.3465-3471
• Main Authors: Zhang, Yi, Jiang, Ge-Ning, Gao, Wen, Chen, Chang
• Format: Article
• Language: English
• Subjects: Adult; Aged; Carcinoma, Non-Small-Cell Lung - surgery; Female; Humans; Lung - pathology; Lung - surgery; Male; Middle Aged; Multivariate Analysis; Postoperative Complications; Retrospective Studies; 一氧化碳; 二氧化碳分压; 切除术; 多因素分析; 术前准备; 肺功能; 非小细胞肺癌; 预测因子
• ISSN: 0366-6999; 2542-5641
• DOI: 10.3760/cma.j.issn.0366-6999.2012.19.019

Background Radical lung resection is the best chance for cure in patients with anatomically resectable non-small cell lung cancer. A retrospective study was performed in an attempt to investigate general rules of major lung resection for non-small cell lung cancer in patients with compromised pulmonary function. Methods Between June 2002 and December 2008, major lung resection was performed in 127 non-small cell lung cancer patients at our institution, who met the criteria of compromised pulmonary function defined as preoperative forced vital capacity 〈50% of prediction or preoperative forced expiratory volume in one second 〈50% of prediction. Clinical data of the patients were retrospectively reviewed. Results The patients consisted of 108 males （85.0%） and 19 females （15.0%） with a mean age of 61.7 years. The morbidity rate was 44.1% （56/127） and the mortality rate was 4.7% （6/127）. Multivariate analysis identified PaCO2 （P=0.023, OR=2.959, 95% Cl 1.164-7.522）, the percent predicted postoperative diffusing capacity of the lung for carbon monoxide （P=0.001, OR=0.176, 95% Cl 0.064-0.480） and comprehensive preoperative preparation （P=0.048, OR=0.417, 95% Cl 0.176-0.993） as the independent predictors of postoperative cardiopulmonary complications that were found in 45 cases. Overall 1-, 3- and 5-year survival rates were 90%, 55% and 37% respectively. For overall survival, multivariate analysis revealed that TNM staging （P=0.004, OR=1.585, 95% Cl 1.154-2.178） was the only independent prognostic factor. Conclusions On the premise of integrated preoperative evaluation and comprehensive preoperative preparation, major lung resection provides an optimal therapeutic for selected non-small cell lung cancer patients with compromised pulmonary function. Hypercapnea and the percent predicted postoperative diffusing capacity of the lung for carbon monoxide 〈40% could be considered as the independent predictive factors for operative risk in those Datients.