Prediction of pulmonary complications after a lobectomy in patients with non-small cell lung cancer
- H Uramotoa,
- R Nakanishib,
- Y Fujinoc,
- H Imotoa,
- M Takenoyamaa,
- T Yoshimatsua,
- T Oyamaa,
- T Osakia,
- K Yasumotoa
- aDepartment of Surgery II, School of Medicine, University of Occupational and Environmental Health, School of Medicine, 1-1 Iseigaoka Yahatanishi-ku, Kitakyushu 807-8555, Japan, bDepartment of Thoracic Surgery, Shin-Kokura Hospital, Kitakyushu, Japan, cClinical Epidemiology, School of Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
- Dr H Uramotohidetaka{at}med.uoeh-u.ac.jp
- Received 1 June 2000
- Revision requested 26 July 2000
- Revised 15 August 2000
- Accepted 18 September 2000
Abstract
BACKGROUND Although the preoperative prediction of pulmonary complications after lung major surgery has been reported in various papers, it still remains unclear.
METHODS Eighty nine patients with stage I–IIIA non-small cell lung cancer (NSCLC) who underwent a complete resection at our institute from 1994–8 were evaluated for the feasibility of making a preoperative prediction of pulmonary complications. All had either a predicted postoperative forced vital capacity (FVC) of >800 ml/m2 or forced expiratory volume in one second (FEV1) of >600 ml/m2.
RESULTS Postoperative complications occurred in 37 patients (41.2%) but no patients died during the 30 day period after the operation. Pulmonary complications occurred in 20 patients (22.5%). Univariate analysis indicated that the factors significantly related to pulmonary complications were FVC <80%, serum lactate dehydrogenase (LDH) level ≥230 U/l, and arterial oxygen tension (Pao 2) <10.6 kPa (80 mm Hg). In a multivariate analysis the three independent predictors of pulmonary complications were serum LDH ≥230 U/l (odds ratio (OR) 10.5, 95% CI 1.4 to 77.3), residual volume (RV)/total lung capacity (TLC) ≥30% (OR 6.0, 95% CI 1.1 to 33.7), and Pao 2 <10.6 kPa (OR 5.6, 95% CI 1.4 to 22.2).
CONCLUSIONS The above findings indicate that three factors (serum LDH levels of ≥230 U/l, RV/TLC ≥30%, and Pao 2 <10.6 kPa) may be associated with pulmonary complications in patients undergoing a lobectomy for NSCLC, even though the patient group was relatively small for statistical analysis of such a diverse subject as pulmonary complications.
