Different recovery from respiratory failure and functional changes after lung cancer surgery depending on the extent of resection, the influence of COPD
BACKGROUNDLung cancer is recognized to be the main cause of cancer death worldwide and it is closely associated with cigarette smoking and chronic obstructive pulmonary disease (COPD). Only about 15% of patients affected by lung cancer are suitable for surgery and the clinical postoperative outcomes are variable.We aim to investigate the variables that affect post-surgery complications .METHODS A sample of 65 COPD patients who underwent surgery for lung cancer was retrospectively studied about
... vely studied about respiratory function and arterial gasanalysis .Data were collected before and after surgery.A subgroups comparative analysis was performed between group who underwent lobectomy vs group who underwent sub-lobar resection represented by either wedge or segmentectomy.RESULTSThe overall data were: mean age 71.5, hospitalization time 7.8 days, pack-year 34, body mass index (BMI) 25.4, chronic obstructive pulmonary disease(COPD) assessment test (CAT) mean value was 16.5, forced expiratory one second volume (FEV1) at baseline 1.6 l corresponding to 73.6% of predicted.The mean age was 71.5, males/females rate 35/30The prevalent stage was IA and prevalent histotype was adenocarcinoma.Among the variables affecting the long lasting oxygen therapy (24 hours a day) only the type of surgery along with presence of COPD showed a significant impact.The relationship between the type of surgery and the lasting of oxygen therapy after surgery showed that lobectomy was 90% more likely to be associated with long lasting oxygen therapy than sub-lobar resection (p<0.0005). Abnormal CAT questionnaire > 10 was also associated with greater risk of long lasting daily oxygen therapy(p<0.04).The subgroups were comparable for age and pack-year , and for PaO2, FEV 1 and FVC at baseline. A significant difference was observed in terms of hospitalization time (p<0.03) that was longer in group of lobectomy and PaO2 post-surgery (p<0.04).Changes between pre and post surgery about the main functional parameters FEV1 and FVC revealed a greater reduction of the above in the group who underwent lobectomy (p<0.001) compared with group treated with sub-lobar resection.The recovery from lung failure was higher in group with sublobar resection at 3 month check.CONCLUSIONSAll patients affected by lung cancer who undergo surgery report lung failure of different intensity depending on the type of surgery.COPD itself could influence the outcome, too. A greater negative variations of functional parameters after surgery is found in group who undergo lobectomy.