Predictive factors inhibiting recovery of the respiratory function after anatomical pulmonary resection

• Published in: Surgery today (Tokyo, Japan) Vol. 53; no. 9; pp. 1081 - 1088
• Main Authors: Ueno, Hiroyasu, Takamochi, Kazuya, Hirayama, Shunki, Fukui, Mariko, Hattori, Aritoshi, Matsunaga, Takeshi, Banno, Takamitsu, Suzuki, Kenji
• Format: Journal Article
• Language: English
• Published: Singapore Springer Nature Singapore 01-09-2023
• Subjects: Medicine; Medicine & Public Health; Original Article; Surgery; Surgical Oncology; Predicted postoperative pulmonary function; Pleurodesis; Lung cancer
• ISSN: 0941-1291; 1436-2813
• DOI: 10.1007/s00595-023-02666-0

Purpose
Some patients have worse actual observed postoperative (apo) respiratory function values than predicted postoperative (ppo) values. The present study therefore clarified the predictive factors that hinder the recovery of the postoperative respiratory function.
Methods
This study enrolled 255 patients who underwent anatomical pulmonary resection for lung cancer. A pulmonary function test (PFT) was carried out before surgery and at one, three, and six months after surgery. In each surgical procedures, the forced expiratory volume in 1 s (FEV1) ratio was calculated as the apo value divided by the ppo value. In addition, we investigated the predictive factors that inhibited postoperative respiratory function improvement in patients with an FEV1 ratio < 1.0 at 6 months after surgery.
Results
The FEV1 ratio gradually improved over time in all surgical procedures. However, 49 of 196 patients who underwent a PFT at 6 months after surgery had an FEV1 ratio < 1.0. In a multivariate analysis, right side, upper lobe, segmentectomy and pleurodesis for prolonged air leakage were independent significant predictors of a decreased FEV1 ratio (p = 0.003, 0.006, 0.001, and 0.009, respectively).
Conclusion
Pleurodesis was the only controllable factor that might help preserve the postoperative respiratory function. Thus, the intraoperative management of air leakage is important.