Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지
DOI QR코드

DOI QR Code

Different DLCO Parameters as Predictors of Postoperative Pulmonary Complications in Mild Chronic Obstructive Pulmonary Disease Patients with Lung Cancer

  • Mil Hoo Kim (Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital) ;
  • Joonseok Lee (Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital) ;
  • Joung Woo Son (Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital) ;
  • Beatrice Chia-Hui Shih (Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital) ;
  • Woohyun Jeong (Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital) ;
  • Jae Hyun Jeon (Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital) ;
  • Kwhanmien Kim (Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital) ;
  • Sanghoon Jheon (Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital) ;
  • Sukki Cho (Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital)
  • Received : 2024.01.24
  • Accepted : 2024.05.07
  • Published : 2024.09.05
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Numerous studies have investigated methods of predicting postoperative pulmonary complications (PPCs) in lung cancer surgery, with chronic obstructive pulmonary disease (COPD) and low forced expiratory volume in 1 second (FEV1) being recognized as risk factors. However, predicting complications in COPD patients with preserved FEV1 poses challenges. This study considered various diffusing capacity of the lung for carbon monoxide (DLCO) parameters as predictors of pulmonary complication risks in mild COPD patients undergoing lung resection. Methods: From January 2011 to December 2019, 2,798 patients undergoing segmentectomy or lobectomy for non-small cell lung cancer (NSCLC) were evaluated. Focusing on 709 mild COPD patients, excluding no COPD and moderate/severe cases, 3 models incorporating DLCO, predicted postoperative DLCO (ppoDLCO), and DLCO divided by the alveolar volume (DLCO/VA) were created for logistic regression. The Akaike information criterion and Bayes information criterion were analyzed to assess model fit, with lower values considered more consistent with actual data. Results: Significantly higher proportions of men, current smokers, and patients who underwent an open approach were observed in the PPC group. In multivariable regression, male sex, an open approach, DLCO <80%, ppoDLCO <60%, and DLCO/VA <80% significantly influenced PPC occurrence. The model using DLCO/VA had the best fit. Conclusion: Different DLCO parameters can predict PPCs in mild COPD patients after lung resection for NSCLC. The assessment of these factors using a multivariable logistic regression model suggested DLCO/VA as the most valuable predictor.

Keywords

References

  1. Barta JA, Powell CA, Wisnivesky JP. Global epidemiology of lung cancer. Ann Glob Health 2019;85:8. https://doi.org/10.5334/aogh.2419
  2. Howington JA, Blum MG, Chang AC, Balekian AA, Murthy SC. Treatment of stage I and II non-small cell lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013;143(5 Suppl):e278S-e313S. https://doi.org/10.1378/chest.12-2359
  3. Cavailles A, Brinchault-Rabin G, Dixmier A, et al. Comorbidities of COPD. Eur Respir Rev 2013;22:454-75. https://doi.org/10.1183/09059180.00008612
  4. Zhao G, Li X, Lei S, Zhao H, Zhang H, Li J. Prevalence of lung cancer in chronic obstructive pulmonary disease: a systematic review and meta-analysis. Front Oncol 2022;12:947981. https://doi.org/10.3389/fonc.2022.947981
  5. Agusti A, Celli BR, Criner GJ, et al. Global Initiative for Chronic Obstructive Lung Disease 2023 report: GOLD executive summary. Eur Respir J 2023;61:2300239. https://doi.org/10.1183/13993003.00239-2023
  6. Licker MJ, Widikker I, Robert J, et al. Operative mortality and respiratory complications after lung resection for cancer: impact of chronic obstructive pulmonary disease and time trends. Ann Thorac Surg 2006;81:1830-7. https://doi.org/10.1016/j.athoracsur.2005.11.048
  7. Wong DH, Weber EC, Schell MJ, Wong AB, Anderson CT, Barker SJ. Factors associated with postoperative pulmonary complications in patients with severe chronic obstructive pulmonary disease. Anesth Analg 1995;80:276-84. https://doi.org/10.1097/00000539-199502000-00013
  8. Ferguson MK, Reeder LB, Mick R. Optimizing selection of patients for major lung resection. J Thorac Cardiovasc Surg 1995;109:275-83. https://doi.org/10.1016/S0022-5223(95)70389-6
  9. Ferguson MK, Watson S, Johnson E, Vigneswaran WT. Predicted postoperative lung function is associated with all-cause long-term mortality after major lung resection for cancer. Eur J Cardiothorac Surg 2014;45:660-4. https://doi.org/10.1093/ejcts/ezt462
  10. van der Lee I, van Es HW, Noordmans HJ, van den Bosch JM, Zanen P. Alveolar volume determined by single-breath helium dilution correlates with the high-resolution computed tomography-derived non-emphysematous lung volume. Respiration 2006;73:468-73. https://doi.org/10.1159/000088711
  11. Ding J, Tarokh V, Yang Y. Bridging AIC and BIC: a new criterion for autoregression. IEEE Trans Inf Theory 2017;64:4024-43. https://doi.org/10.1109/TIT.2017.2717599
  12. Markos J, Mullan BP, Hillman DR, et al. Preoperative assessment as a predictor of mortality and morbidity after lung resection. Am Rev Respir Dis 1989;139:902-10. https://doi.org/10.1164/ajrccm/139.4.902
  13. Bousamra M 2nd, Presberg KW, Chammas JH, et al. Early and late morbidity in patients undergoing pulmonary resection with low diffusion capacity. Ann Thorac Surg 1996;62:968-75. https://doi.org/10.1016/0003-4975(96)00476-6
  14. Ferguson MK, Dignam JJ, Siddique J, Vigneswaran WT, Celauro AD. Diffusing capacity predicts long-term survival after lung resection for cancer. Eur J Cardiothorac Surg 2012;41:e81-6. https://doi.org/10.1093/ejcts/ezs049
  15. Cerfolio RJ, Bryant AS. Different diffusing capacity of the lung for carbon monoxide as predictors of respiratory morbidity. Ann Thorac Surg 2009;88:405-11. https://doi.org/10.1016/j.athoracsur.2009.04.015
  16. Sekine Y, Behnia M, Fujisawa T. Impact of COPD on pulmonary complications and on long-term survival of patients undergoing surgery for NSCLC. Lung Cancer 2002;37:95-101. https://doi.org/10.1016/s0169-5002(02)00014-4
  17. Vrieze SI. Model selection and psychological theory: a discussion of the differences between the Akaike information criterion (AIC) and the Bayesian information criterion (BIC). Psychol Methods 2012;17:228-43. https://doi.org/10.1037/a0027127
  18. Lee H, Kim HK, Kang D, et al. Prognostic value of 6-Min Walk Test to predict postoperative cardiopulmonary complications in patients with non-small cell lung cancer. Chest 2020;157:1665-73. https://doi.org/10.1016/j.chest.2019.12.039