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

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 (%DLco ppo»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 200l. Preoperative pulmonary function tests included vital capacity (VC), %VC, forced expiratory volume in one second (FEVl.o), FEVI.O %, diffusion capacity for carbon monoxide (DLco ), predictive postoperative FEVl.o (FEVI.Oppo), postoperative respi­ ratory function expressed as a percentage of the predicted normal value (%FEV 1.0 ppo, %DLcoppo). Postoperative complications were divided into 2 groups: respira­ tory complications (pneumonia, atelectasis, etc) and other complications (broncho­ pleural 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 FEVI.0~1,500 ml did not die of respiratory complications. Patients undergoing pneumonectomy with FEVI.OPpo~800 ml/m2 did not die of respiratory complications. Patients undergoing pneumonectomy with %FEVI.Oppo<40% and %DLcoppo<40% did not survive. Five of the 7 patients who died of respiratory complications were treated with preoperative chemother- ~~~-, ~~~=, ~*~ff,~ ft,~D*~, *~~, *E~., ~~~­