Bibliographic Details
| Title: |
A New Functional Threshold for Minimally Invasive Lobectomy. |
| Authors: |
Vanstraelen, Stijn, Kay See Tan, Dycoco, Joe, Adusumilli, Prasad S., Bains, Manjit S., Bott, Matthew J., Downey, Robert J., Gray, Katherine D., Huang, James, Isbell, James M., Molena, Daniela, Park, Bernard J., Rusch, Valerie W., Sihag, Smita, Jones, David R., Rocco, Gaetano |
| Source: |
Annals of Surgery; Dec2024, Vol. 280 Issue 6, p1029-1037, 9p |
| Abstract: |
Objective: To assess the performance of a lower predicted postoperative (ppo) forced expiratory volume in 1 second (FEV1) or diffusion capacity of the lung for carbon monoxide (DLCO) (ppo-FEV1/ppoDLCO) threshold to predict cardiopulmonary complications after minimally invasive surgery (MIS) lobectomy. Background: Although MIS is associated with better postoperative outcomes than open surgery, MIS uses risk-assessment algorithms developed for open surgery. Moreover, several different definitions of cardiopulmonary complications are used for assessment. Methods: All patients who underwent MIS lobectomy for clinical stage I to II lung cancer from 2018 to 2022 at our institution were considered. The performance of a ppoFEV1/ppoDLCO threshold of <45% was compared against that of the current guideline threshold of <60%. Three different definitions of cardiopulmonary complications were compared: Society of Thoracic Surgeons (STS), European Society of Thoracic Surgeons (ESTS), and Berry and colleagues' study. Results: In 946 patients, the ppoFEV1/ppoDLCO threshold of < 45% was associated with a higher proportion correctly classified [79% (95% CI, 76%-81%) vs 65% (95% CI, 62%-68%); P< 0.001]. The complication with the biggest difference in incidence between ppoFEV1/ppoDLCO of 45% to 60% and >60% was prolonged air leak [33 (13%) vs 34 (6%); P< 0.001]. The predicted probability curves for cardiopulmonary complications were higher for the STS definition than for the ESTS or Berry definitions across ppoFEV1 and ppoDLCO values. Conclusions: The ppoFEV1/ppoDLCO threshold of <45% more accurately classified patients for cardiopulmonary complications after MIS lobectomy, emphasizing the need for updated riskassessment guidelines for MIS lobectomy to optimize additional cardiopulmonary function evaluation. [ABSTRACT FROM AUTHOR] |
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| Database: |
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