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J Thorac Cardiovasc Surg. 2014 Jul;148(1):19-28, dicussion 28-29.e1. doi: 10.1016/j.jtcvs.2014.03.007. Epub 2014 Mar 13.

Thoracoscopic lobectomy is associated with acceptable morbidity and mortality in patients with predicted postoperative forced expiratory volume in 1 second or diffusing capacity for carbon monoxide less than 40% of normal.

Author information

1
Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif. Electronic address: bburt@stanford.edu.
2
Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC.
3
Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif.
4
Division of Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
5
Department of Cardiothoracic Surgery, Maine Medical Center, Portland, Maine.

Abstract

OBJECTIVE:

A predicted postoperative (ppo) forced expiratory volume in 1 second (FEV1%) or diffusing capacity of the lung for carbon monoxide (DLCO%) of <40% has traditionally been considered to convey a high risk of lobectomy owing to elevated postoperative morbidity and mortality. These recommendations, however, were largely derived from the pre-video-assisted thoracoscopic surgical (VATS) era. We hypothesized that VATS lobectomy would be associated with acceptable morbidity and mortality at ppoFEV1% and ppoDLCO% values < 40%.

METHODS:

PpoFEV1% and ppoDLCO% were calculated for patients undergoing open or VATS lobectomy for lung cancer in the Society of Thoracic Surgeons General Thoracic database from 2009 to 2011. Univariate comparisons, multivariate analyses, and 1:1 propensity matching were performed.

RESULTS:

A total of 13,376 patients underwent lobectomy (50.9% open, 49.1% VATS). A decreased ppoFEV1% and ppoDLCO% were each independent predictors for both cardiopulmonary complications and mortality in the open group (all P ≤ .008). In the VATS group, ppoFEV1% was an independent predictor of complications (P = .001) but not mortality (P = .77), and ppoDLCO% was an independent predictor of complications (P = .046) and mortality (P = .008). With decreasing ppoFEV1% or ppoDLCO%, complications and mortality increased at a greater rate in the open lobectomy than in a propensity-matched VATS group (n = 4215 each). For patients with ppoFEV1% < 40%, mortality was greater in the open (4.8%) than in the matched VATS group (0.7%, P = .003). Similar results were seen for ppoDLCO% < 40% (5.2% open, 2.0% VATS, P = .003). The rate of complications was significantly greater at ppoFEV1% < 40% in the open (21.9%) than in the matched VATS (12.8%, P = .005) group and similar results were seen with ppoDLCO% < 40% (14.9% open, 10.4% VATS, P = .016).

CONCLUSIONS:

VATS lobectomy can be performed with acceptable rates of morbidity and mortality in patients with reduced ppoFEV1% or ppoDLCO%.

PMID:
24766848
DOI:
10.1016/j.jtcvs.2014.03.007
[Indexed for MEDLINE]
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