- •Forced expiratory volume in 1 second as percent of predicted (FEV1%) is an important component of pulmonary function tests (PFTs).
- •Reduced preoperative FEV1% correlates with increased intraoperative estimated blood loss and skin-to-skin operative times.
- •Reduced preoperative FEV1% also correlates with increased rates of postoperative arrhythmias requiring intervention, prolonged air leak >5 days, mucous plug formation, hypoxia, pneumonia, and total postoperative complications.
- •Patients with reduced preoperative FEV1% have shorter median overall survival after pulmonary lobectomy.
- •Preoperative PFTs can help determine patients at risk for postoperative morbidity.
Effects of pulmonary function test (PFT) results on perioperative outcomes were investigated after robotic-assisted video-thoracoscopic (RAVT) pulmonary lobectomy.
We retrospectively analyzed 706 consecutive patients who underwent RAVT lobectomy by one surgeon over 10.8 years. Preoperative (preop) forced expiratory volume in one second as a percent of predicted (FEV1%) was used to group patients as having normal FEV1% (≥80%) versus reduced FEV1% (<80%). Demographics, preop comorbidities, intraoperative (intraop) and postoperative (postop) complications, perioperative outcomes, and median survival time (MST) were compared across patients with normal vs. reduced FEV1% using Chi-Square (X2), Fisher's Exact test, Student's t-test, Kruskal-Wallis test, or Kaplan-Meier analysis respectively, with significance at p ≤ 0.05. Multivariable analysis was performed for perioperative outcomes to investigate the differences across patients in the FEV1% groups.
There were 470 patients with normal FEV1% and 236 patients with reduced FEV1%. The two FEV1% groups did not differ in intraop or postop complication rates, except for higher postop other arrhythmia requiring intervention (p = 0.004), prolonged air leak >5 days (p = 0.002), mucous plug formation (p = 0.009), hypoxia (p < 0.001), and pneumonia (p = 0.002), and total postop complications (p < 0.001) in reduced-FEV1% patients. Reduced FEV1% correlated with increased intraop estimated blood loss (p < 0.0001) and skin-to-skin operative time (p < 0.0001). Median overall survival in patients with normal FEV1% was 93.20 months (95% CI: 76.5–126.0) versus 58.9 months (95% CI: 50.4–68.4) in patients with reduced FEV1% (p = 0.0004).
Patients should have PFTs conducted before surgery to determine at-risk patients. However, RAVT pulmonary lobectomy is feasible and safe even in patients with reduced FEV1%.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to The American Journal of Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Lung cancer: current therapies and new targeted treatments.Lancet. 2017; 389: 299-311
- Scientific advances in lung cancer 2015.J Thorac Oncol. 2016; 11: 613-638
- Robotic-assisted videothoracoscopic surgery of the lung.Cancer Control. 2015; 22: 314-325
- Chronic obstructive pulmonary disease and lung cancer: underlying pathophysiology and new therapeutic modalities.Drugs. 2018; 78: 1717-1740
- Outcomes of lobectomy on pulmonary function for early stage non-small cell lung cancer (NSCLC) patients with chronic obstructive pulmonary disease (COPD).Thoracic Cancer. 2020; 11: 1784-1789
- Minimal alteration of pulmonary function after lobectomy in lung cancer patients with chronic obstructive pulmonary disease.Ann Thorac Surg. 2003; 76: 356-361
- Risk factors and short-term outcomes of postoperative pulmonary complications after VATS lobectomy.J Cardiothorac Surg. 2018; 13: 28
- The natural history of chronic airflow obstruction revisited.Am J Respir Crit Care Med. 2009; 180: 3-10
- Systematic review with meta-analysis of the epidemiological evidence relating FEV1decline to lung cancer risk.BMC Cancer. 2012; 12: 498
- Effect of insurance type on perioperative outcomes after robotic-assisted pulmonary lobectomy for lung cancer.Surgery. 2019; 166: 211-217
- Severity of chronic obstructive pulmonary disease and its relationship to lung cancer prognosis after surgical resection.Thorac Cardiovasc Surg. 2013; 61: 124-130
- Effect of comorbidities on long-term outcomes after thoracoscopic surgery for stage I non-small cell lung cancer patients with chronic obstructive pulmonary disease.J Thorac Dis. 2018; 10: 909-919
- Impact of COPD on pulmonary complications and on long-term survival of patients undergoing surgery for NSCLC.Lung Cancer. 2002; 37: 95-101
- Effect of lowest postoperative pre-albumin on outcomes after robotic-assisted pulmonary lobectomy.Jsls. 2021; 25
- Effect of gender on perioperative outcomes after robotic-assisted pulmonary lobectomy.J Thorac Dis. 2016; 8: 3614-3624
- Early and long-term results of lung resection for non-small-cell lung cancer in patients with severe ventilatory impairment.Eur J Cardio Thorac Surg. 2005; 27: 1099-1105
Accepted: February 22, 2023
Received in revised form: February 7, 2023
Received: September 25, 2022
Publication stageIn Press Journal Pre-Proof
© 2023 Published by Elsevier Inc.