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J Surg Oncol. 2018 Dec;118(8):1285-1291. doi: 10.1002/jso.25289. Epub 2018 Nov 6.

The everlasting issue of prolonged air leaks after lobectomy for non-small cell lung cancer: A data-driven prevention planning model in the era of minimally invasive approaches.

Author information

1
Division of Thoracic Surgery, Department of Surgery, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Italy.
2
Department of Cardiothoracic Surgery, Sheffield Teaching Hospitals NHS Trust, Northern General Hospital, Sheffield, UK.
3
Department of General Thoracic Surgery, Virgen Macarena University Hospital, Seville, Spain.
4
Department of Surgery, Competence Center of Thoracic Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany.
5
Department of General Thoracic Surgery, Fondazione Policlinico "A.Gemelli" - Catholic University of Sacred Heart, Rome, Italy.
6
Department of Thoracic Surgery, University General Hospital Alicante, Alicante, Spain.

Abstract

BACKGROUND AND OBJECTIVES:

Prolonged air leaks (PAL) are the most frequent complication after lobectomy for non-small cell lung cancer, even in case of minimally invasive approaches. We developed a novel score to identify high-risk patients for PAL during minimally invasive lobectomy.

METHODS:

A dedicated database was created. We investigated preoperative candidate features and specific intraoperative variables. Univariate and subsequent logistic regression analysis with bootstrap resampling have been used. Model performance has been assessed by reckoning the area under the receiver operating characteristics curve and the Hosmer-Lemeshow goodness of fit.

RESULTS:

PAL (>5 days) occurred in 72 (15.69%) patients. Five variables emerged from the model. Each one was assigned a score to provide a cumulative scoring system: forced expiratory volume in 1 second below 86% (P = 0.004, 1.5 points), body mass index <24 ( P = 0.002, 1 point), active smoking ( P = 0.001, 1.5 points), incomplete fissures ( P = 0.004, 1.5 points), and adhesions ( P = 0.0001, 1 point). The new score provided a stratification into four risk classes.

CONCLUSIONS:

The risk score incorporates either general or more specific variables, providing a risk stratification that could be readily applied intra- and postoperatively. Henceforth, specific technical and management measures could be properly allocated to curb PAL.

KEYWORDS:

air leaks; complications; lung cancer; predictive models; video-assisted thoracoscopic (VATS) lobectomy

PMID:
30399200
DOI:
10.1002/jso.25289
[Indexed for MEDLINE]

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