Morbidity, mortality, and categorization of the risk of perioperative complications in lung cancer patients

Fabiana Stanzani, Denise de Moraes Paisani, Anderson de Oliveira, Rodrigo Caetano de Souza, João Aléssio Juliano Perfeito, Sonia Maria Faresin, Fabiana Stanzani, Denise de Moraes Paisani, Anderson de Oliveira, Rodrigo Caetano de Souza, João Aléssio Juliano Perfeito, Sonia Maria Faresin

Abstract

Objective: To determine morbidity and mortality rates by risk category in accordance with the American College of Chest Physicians guidelines, to determine what role pulmonary function tests play in this categorization process, and to identify risk factors for perioperative complications (PCs).

Methods: This was a historical cohort study based on preoperative and postoperative data collected for cases of lung cancer diagnosed or suspected between 2001 and 2010.

Results: Of the 239 patients evaluated, only 13 (5.4%) were classified as being at high risk of PCs. Predicted postoperative FEV1 (FEV1ppo) was sufficient to define the risk level in 156 patients (65.3%); however, cardiopulmonary exercise testing (CPET) was necessary for identifying those at high risk. Lung resection was performed in 145 patients. Overall morbidity and mortality rates were similar to those reported in other studies. However, morbidity and mortality rates for patients at an acceptable risk of PCs were 31.6% and 4.3%, respectively, whereas those for patients at high risk were 83.3% and 33.3%. Advanced age, COPD, lobe resection, and lower FEV1ppo were correlated with PCs.

Conclusions: Although spirometry was sufficient for risk assessment in the majority of the population studied, CPET played a key role in the identification of high-risk patients, among whom the mortality rate was seven times higher than was that observed for those at an acceptable risk of PCs. The risk factors related to PCs coincided with those reported in previous studies.

Figures

Figure 1. Algorithm proposed by the American…
Figure 1. Algorithm proposed by the American College of Chest Physicians. ppo: predicted postoperative; CPET: cardiopulmonary exercise testing; and VO2peak: peak oxygen uptake.
Figure 2. Preoperative evaluation of 239 lung…
Figure 2. Preoperative evaluation of 239 lung resection candidates as per the American College of Chest Physicians algorithm guidelines. ppo: predicted postoperative; CPET: cardiopulmonary exercise testing; and VO2peak: peak oxygen uptake.
Figura 1. Algoritmo proposto pelo American College…
Figura 1. Algoritmo proposto pelo American College of Chest Physicians . ppo: previsto no pós-operatório; TECP: teste de exercício cardiopulmonar; e VO2pico: consumo de oxigênio no pico do exercício.
Figura 2. Avaliação pré-operatória de 239 candidatos…
Figura 2. Avaliação pré-operatória de 239 candidatos à ressecção pulmonar segundo as orientações do algoritmo do American College of Chest Physicians . ppo: previsto no pós-operatório; TECP: teste de exercício cardiopulmonar; e VO2pico: consumo de oxigênio no pico do exercício.

References

    1. Colice GL, Shafazand S, Griffin JP, Keenan R, Bolliger CT, American College of Chest Physicians Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: ACCP evidenced-based clinical practice guidelines (2nd edition) Chest. 2007;132(3 Suppl):161S–177S.
    1. Brunelli A, Charloux A, Bolliger CT, Rocco G, Sculier JP, Varela G, et al. ERS/ESTS clinical guidelines on fitness for radical therapy in lung cancer patients (surgery and chemo-radiotherapy) Eur Respir J. 2009;34(1):17–41.
    1. Bolliger CT, Jordan P, Solèr M, Stulz P, Grädel E, Skarvan K, et al. Exercise capacity as a predictor of postoperative complications in lung resection candidates. Am J Respir Crit Care Med. 1995;151(5):1472–1480.
    1. Wyser C, Stulz P, Solèr M, Tamm M, Müller-Brand J, Habicht J, et al. Prospective evaluation of an algorithm for the functional assessment of lung resection candidates. Pt 1Am J Respir Crit Care Med. 1999;159(5):1450–1456.
    1. Charloux A, Brunelli A, Bolliger CT, Rocco G, Sculier JP, Varela G, et al. Lung function evaluation before surgery in lung cancer patients: how are recent advances put into practice? A survey among members of the European Society of Thoracic Surgeons (ESTS) and of the Thoracic Oncology Section of the European Respiratory Society (ERS) Interact Cardiovasc Thorac Surg. 2009;9(6):925–931.
    1. Ferguson MK, Stromberg JD, Celauro AD. Estimating lung resection risk: a pilot study of trainee and practicing surgeons. Ann Thorac Surg. 2010;89(4):1037-42; discussion 1042-3.
    1. Stanzani F, Oliveira MA, Forte V, Faresin SM. Torrington and Henderson and Epstein risk assessment scales: applicability and effectiveness in lung resection. J Bras Pneumol. 2005;31(4):292–299.
    1. Harpole DH Jr, DeCamp MM, Jr, Daley J, Hur K, Oprian CA, Henderson WG, et al. Prognostic models of thirty-day mortality and morbidity after major pulmonary resection. J Thorac Cardiovasc Surg. 1999;117(5):969–979.
    1. Boffa DJ, Allen MS, Grab JD, Gaissert HA, Harpole DH, Wright CD. Data from The Society of Thoracic Surgeons General Thoracic Surgery database: the surgical management of primary lung tumors. J Thorac Cardiovasc Surg. 2008;135(2):247–254.
    1. Sánchez PG, Vendrame GS, Madke GR, Pilla ES, Camargo Jde J, Andrade CF, et al. Lobectomy for treating bronchial carcinoma: analysis of comorbidities and their impact on postoperative morbidity and mortality. J Bras Pneumol. 2006;32(6):495–504.
    1. Ferguson MK, Little L, Rizzo L, Popovich KJ, Glonek GF, Leff A, et al. Diffusing capacity predicts morbidity and mortality after pulmonary resection. J Thorac Cardiovasc Surg. 1988;96(6):894–900.
    1. Ferguson MK, Gaissert HA, Grab JD, Sheng S. Pulmonary complications after lung resection in the absence of chronic obstructive pulmonary disease: the predictive role of diffusing capacity. J Thorac Cardiovasc Surg. 2009;138(6):1297–1302.
    1. Brunelli A, Refai MA, Salati M, Sabbatini A, Morgan-Hughes NJ, Rocco G. Carbon monoxide lung diffusion capacity improves risk stratification in patients without airflow limitation: evidence for systematic measurement before lung resection. Eur J Cardiothorac Surg. 2006;29(4):567–570.
    1. Smith TB, Stonell C, Purkayastha S, Paraskevas P. Cardiopulmonary exercise testing as a risk assessment method in non cardio-pulmonary surgery: a systematic review. Anaesthesia. 2009;64(8):883–893.
    1. Older P, Smith R, Hall A, French C. Preoperative cardiopulmonary risk assessment by cardiopulmonary exercise testing. Crit Care Resusc. 2000;2(3):198–208.
    1. Novoa NM, Ramos J, Jiménez MF, González-Ruiz JM, Varela G. The initial phase for validating the European algorithm for functional assessment prior to lung resection: quantifying compliance with the recommendations in actual clinical practice. Arch Bronconeumol. 2012;48(7):229–233.
    1. Brunelli A, Kim AW, Berger KI, Addrizzo-Harris DJ. Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143(5 Suppl):e166S–e190S.
    1. Brunelli A, Refai M, Xiumé F, Salati M, Sciarra V, Socci L, et al. Performance at symptom-limited stair-climbing test is associated with increased cardiopulmonary complications, mortality, and costs after major lung resection. Ann Thorac Surg. 2008;86(1):240-7; discussion 247-8.
    1. Nomori H, Watanabe K, Ohtsuka T, Naruke T, Suemasu K. Six-minute walking and pulmonary function test outcomes during the early period after lung cancer surgery with special reference to patients with chronic obstructive pulmonary disease. Jpn J Thorac Cardiovasc Surg. 2004;52(3):113–119.
    1. Win T, Jackson A, Groves AM, Sharples LD, Charman SC, Laroche CM. Comparison of shuttle walk with measured peak oxygen consumption in patients with operable lung cancer. Thorax. 2006;61(1):57–60.
    1. Ferguson MK, Vigneswaran WT. Changes in patient presentation and outcomes for major lung resection over three decades. Eur J Cardiothorac Surg. 2008;33(3):497–501.
    1. Almanaseer Y, Mukherjee D, Kline-Rogers EM, Kesterson SK, Sonnad SS, Rogers B, et al. Implementation of the ACC/AHA guidelines for preoperative cardiac risk assessment in a general medicine preoperative clinic: improving efficiency and preserving outcomes. Cardiology. 2005;103(1):24–29.
    1. Cagirici U, Nalbantgil S, Cakan A, Turhan K. A new algorithm for preoperative cardiac assessment in patients undergoing pulmonary resection. Tex Heart Inst J. 2005;32(2):159–162.
    1. Smetana GW, Lawrence VA, Cornell JE, American College of Physicians Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians. Ann Intern Med. 2006;144(8):581–595.
    1. Dominguez-Ventura A, Cassivi SD, Allen MS, Wigle DA, Nichols FC, Pairolero PC, et al. Lung cancer in octogenarians: factors affecting long-term survival following resection. Eur J Cardiothorac Surg. 2007;32(2):370–374.
    1. Algar FJ, Alvarez A, Salvatierra A, Baamonde C, Aranda JL, López-Pujol FJ. Predicting pulmonary complications after pneumonectomy for lung cancer. Eur J Cardiothorac Surg. 2003;23(2):201–208.
    1. Birim O, Zuydendorp HM, Maat AP, Kappetein AP, Eijkemans MJ, Bogers AJ. Lung resection for non-small-cell lung cancer in patients older than 70: mortality, morbidity, and late survival compared with the general population. Ann Thorac Surg. 2003;76(6):1796–1801.
    1. Brunelli A, Monteverde M, Al Refai M, Fianchini A. Stair climbing test as a predictor of cardiopulmonary complications after pulmonary lobectomy in the elderly. Ann Thorac Surg. 2004;77(1):266–270.
    1. Ferguson MK, Vigneswaran WT. Changes in patient presentation and outcomes for major lung resection over three decades. Eur J Cardiothorac Surg. 2008;33(3):497–501.

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