Thoracoscopic lobectomy for non-small-cell lung cancer in patients with impaired pulmonary function: analysis from a national database

The objective of this retrospective multi-institutional study was to evaluate the postoperative outcomes of video-assisted thoracoscopic surgery (VATS)-lobectomy (VATS-L) for non-small-cell lung cancer (NSCLC) in patients with impaired lung function. The second end point was to illustrate the effect...

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Bibliographic Details
Published in:Interactive cardiovascular and thoracic surgery 2020-06, Vol.30 (6), p.803-811
Main Authors: Bongiolatti, Stefano, Gonfiotti, Alessandro, Vokrri, Eduart, Borgianni, Sara, Crisci, Roberto, Curcio, Carlo, Voltolini, Luca
Format: Article
Language:English
Subjects:
Aged
Carcinoma, Non-Small-Cell Lung - diagnosis
Carcinoma, Non-Small-Cell Lung - physiopathology
Carcinoma, Non-Small-Cell Lung - surgery
Female
Forced Expiratory Volume - physiology
Humans
Lung - surgery
Lung Neoplasms - diagnosis
Lung Neoplasms - physiopathology
Lung Neoplasms - surgery
Male
Pneumonectomy - methods
Population Surveillance
Postoperative Period
Respiratory Function Tests
Retrospective Studies
Thoracic Surgery, Video-Assisted - methods
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Summary:The objective of this retrospective multi-institutional study was to evaluate the postoperative outcomes of video-assisted thoracoscopic surgery (VATS)-lobectomy (VATS-L) for non-small-cell lung cancer (NSCLC) in patients with impaired lung function. The second end point was to illustrate the effective role of forced expiratory volume in 1 s (FEV1%) and the diffusing capacity of the lung for carbon monoxide (DLCO%) in predicting complications in this population. Data from patients who underwent VATS-L at participating centres were analysed and divided into 2 groups: group A comprised patients with FEV1% and/or DLCO% >60% and group B included patients with impaired lung function defined as FEV1% and/or DLCO% ≤60%. To define clinical predictors of death and complications, we performed univariate and multivariable regression analyses. A total of 5562 patients underwent VATS-L, 809 (14.5%) of whom had impaired lung function. The postoperative mortality rate did not differ between the 2 groups (2.3% vs 3.2%; P = 0.77). The percentage of patients who had any complication (21.4% vs 34.2%; P ≤ 0.001), the complication rate (28% vs 49.8%; P ≤ 0.001) and the length of hospital stay (P ≤ 0.001) were higher for patients with limited pulmonary function. Impaired lung function was a strong predictor of overall and pulmonary complications at multivariable analysis. VATS-L for NSCLC can be performed in patients with impaired lung function without increased risk of postoperative death and with an acceptable incidence of overall and respiratory complications. Our analysis suggested that FEV1% and DLCO% play a substantial role in estimating the risk of complications after VATS-L, but their role was less reliable for estimating the mortality.
ISSN:1569-9293
1569-9285
DOI:10.1093/icvts/ivaa044