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Pulmonary Function Changes Over 1 Year After Lobectomy in Lung Cancer

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Pulmonary Function Changes Over 1 Year After Lobectomy in Lung Cancer RESPIRATORY CARE Paper in Press. Published on November 24, 2015 as DOI: 10.4187/respcare.04284 Pulmonary Function Changes Over 1 Year After Lobectomy in Lung Cancer Hyun Koo Kim MD PhD, Yoo Jin Lee MSc, Kook Nam Han MD PhD, and Young Ho Choi MD PhD BACKGROUND: This study was conducted to measure the serial changes in pulmonary function over 12 months after lobectomy in subjects with lung cancer and to evaluate the actual recovery of pulmonary function in comparison with the predicted postoperative values. METHODS: Subjects who underwent lobectomy for primary lung cancer were included in this study. In the statistical analysis, we included data from 76 subjects (52 men and 24 women; mean age, 63.4 y) who completed perfusion scintigraphy 1 week before surgery and FEV1 and diffusion capacity of the lung for carbon monoxide (DLCO) assessments preoperatively and at 1, 6, and 12 months postop- eratively. RESULTS: The actual percent-of-predicted FEV1 1 month postoperatively was 77.9% of the preoperative value, which was almost equal to the predicted postoperative value, and signifi- cantly increased to 84.3% by 6 months and 84.2% at 12 months. The actual percent-of-predicted DLCO 1 month postoperatively was 81.8% of the preoperative value, which was similar to the predicted postoperative value, and also significantly increased to 91.3% at 6 months and 96.5% at 12 months. However, the actual pulmonary function test results at1yinsubjects with COPD or in those who underwent thoracotomy or received adjuvant chemotherapy were not different from the predicted postoperative values. CONCLUSIONS: Actual pulmonary function compared with pre- dicted postoperative values improved over time over 1 y after lobectomy. However, this improve- ment was not observed in subjects with COPD or in those who underwent thoracotomy or received postoperative adjuvant chemotherapy. Key words: pulmonary function; lobectomy; lung cancer. [Respir Care 0;0(0):1–•. © 0 Daedalus Enterprises] Introduction non-small-cell lung cancer. However, in some subjects with early stage non-small-cell lung cancer, poor respira- Lung cancer is one of the most common malignancies tory function may interfere with surgery because of the and is one of the leading causes of death worldwide.1 increased risk for perioperative morbidity and mortality Surgical resection has been regarded as the best treatment and the possibility of long-term postoperative disability 2 3 for controlling stage I, stage II, and part of stage IIIA secondary to respiratory insufficiency. Baser et al re- ported that 37% of subjects who had anatomically resect- able lung cancers were excluded from surgical resection only because of poor lung function. Therefore, predicting Drs Kim, Han, and Choi are affiliated with the Departments of Thoracic postoperative pulmonary function, particularly FEV and and Cardiovascular Surgery, Korea University Guro Hospital, Korea Uni- 1 versity College of Medicine, Seoul, Korea. Ms Lee is affiliated with the the diffusion capacity of the lung for carbon monoxide Korea University College of Medicine, Seoul, Korea. This research was supported by Ministry of Education, Science, and Technology Grant 20120003904; the National Research Foundation of Korea (NRF) grant, funded by the Korean government (MEST) (Grant Correspondence: Hyun Koo Kim MD PhD, Departments of Thoracic and 2012012166); and the Korean Health Technology R&D Project, Ministry Cardiovascular Surgery, Korea University Guro Hospital, Korea Univer- of Health and Welfare, Republic of Korea (Grant A121074). The authors sity College of Medicine, 97 Guro-donggil, Guro-gu, Seoul 152-703, have disclosed no conflicts of interest. Korea. E-mail: [email protected]. Dr Kim and Ms Lee contributed equally to this work. DOI: 10.4187/respcare.04284 RESPIRATORY CARE • ●●VOL ● NO ● 1 Copyright (C) 2015 Daedalus Enterprises ePub ahead of print papers have been peer-reviewed, accepted for publication, copy edited and proofread. However, this version may differ from the final published version in the online and print editions of RESPIRATORY CARE RESPIRATORY CARE Paper in Press. Published on November 24, 2015 as DOI: 10.4187/respcare.04284 PULMONARY FUNCTION AFTER LOBECTOMY (DLCO), plays an important role in determining candidates for surgical resection and the extent of resection.4 QUICK LOOK A number of related studies have been conducted to Current knowledge predict pulmonary function after surgery.5 However, reach- ing a definitive conclusion about predicting postoperative Lung cancer is one of the most common malignancies pulmonary function was difficult in most of these studies and a leading cause of death worldwide. Surgical re- because they were based on small samples and short mon- section is the standard of care in non-small-cell lung cancer. Poor respiratory function may preclude surgery itoring periods (3 or 6 months at the longest).6-8 Further- more, surgical techniques and postoperative care have in select patients due to the increased risk for periop- steadily improved since these studies were performed. erative morbidity and mortality. Long-term postopera- Recently, the authors showed that actual pulmonary func- tive disability secondary to respiratory failure repre- tion results at approximately 1 month after surgery were sents a significant cost burden. similar to predicted postoperative pulmonary function val- What this paper contributes to our knowledge ues.9 In addition, Brunelli et al10 performed a prospective study of a large sample (Ͼ200 subjects) and found that Actual pulmonary function compared with predicted actual postoperative lung function reached predicted post- postoperative values improved 1 y after lobectomy. This operative values at 1 month after surgery and showed fur- improvement was not observed in subjects with COPD, ther improvement at 3 months after surgery. Based on in those who underwent thoracotomy, or those who these studies, we aimed to evaluate whether pulmonary received postoperative adjuvant chemotherapy. function would continue to improve during the long-term follow-up after operation, and in the present study, we monitored the changes in actual postoperative lung func- tion over 1 y after lobectomy in subjects with lung cancer DLCO was measured using the single-breath method. Spi- and evaluated the degree of actual recovery compared rometry and DLCO results were collected after bronchodi- with predicted postoperative values. In addition, we an- lator administration and are expressed as percentages of alyzed differences in the results according to factors age, sex, and height of the subject according to the Euro- including the presence or absence of COPD, surgical pean Community for Steel and Coal prediction equations.12 method (video-assisted thoracoscopic surgery [VATS] The preoperative radionuclide quantitative lung perfu- vs thoracotomy), and the use of adjuvant chemotherapy sion scans were performed in all subjects with an Infinia after operation. multidetector system (GE Medical Systems, Haifa, Israel) to estimate the predicted postoperative values, as described Methods by Ali,13, which was our routine procedure until January ϭ 2009: (1) postoperative percent-of-predicted FEV1 pre- ϫ Ϫ Subjects who underwent lobectomy for primary lung operative percent-of-predicted FEV1 (100% projected cancer from April 2009 through January 2012 at Korea percentage loss of lung function) and (2) postoperative ϭ University Guro Hospital were included in this study. Sub- percent-of-predicted DLCO preoperative percent-of-pre- ϫ Ϫ ject data were prospectively collected and were analyzed. dicted DLCO (100% projected percentage loss of lung Exclusionary criteria included cancer with chest wall in- function). vasion, endobronchial cancer with post-obstructive pneu- monitis, and subjects who underwent neoadjuvant chemo- Statistics therapy. Patients who had any major complications or required ventilatory support that interfered with assess- The descriptive statistics of FEV1 and DLCO measure- ment of pulmonary function in the postoperative period ments are presented as the mean and SD. We used paired were also excluded. This study was approved by the Ethics and independent t tests to compare groups with normally Committee of Korea University Guro Hospital (KUGH distributed data and the Wilcoxon signed-rank test and 2014-01-0004), and written informed consent was obtained Mann-Whitney test for non-normal data. Data analysis was from all subjects, in accordance with the Declaration of performed with SPSS 20 (SPSS, Chicago, Illinois). Helsinki. Subjects underwent pulmonary function tests and per- Results fusion scintigraphy within 1 week before surgery and post- operative pulmonary function tests at 1, 6, and 12 months A total of 76 subjects (52 men and 24 women) who after surgery. The pulmonary function tests were performed completed FEV1 and DLCO assessments preoperatively and according to the published guidelines using a spirometer at 1, 6, and 12 months postoperatively were included in the (Vmax22, SensorMedics, Yorba Linda, California).11 The statistical analysis. 2RESPIRATORY CARE • ●●VOL ● NO ● Copyright (C) 2015 Daedalus Enterprises ePub ahead of print papers have been peer-reviewed, accepted for publication, copy edited and proofread. However, this version may differ from the final published version in the online and print editions of RESPIRATORY CARE RESPIRATORY CARE Paper in Press. Published on November 24, 2015 as DOI: 10.4187/respcare.04284 PULMONARY FUNCTION AFTER LOBECTOMY The characteristics
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