Impact of compromised pulmonary function on major lung resection for non-small cell lung cancer: retrospective study...

Radical lung resection is the best chance for cure in patients with anatomically resectable non-small cell lung cancer. A retrospective study was performed in an attempt to investigate general rules of major lung resection for non-small cell lung cancer in patients with compromised pulmonary function.

Between June 2002 and December 2008, major lung resection was performed in 127 non-small cell lung cancer patients at our institution, who met the criteria of compromised pulmonary function defined as preoperative forced vital capacity < 50% of prediction or preoperative forced expiratory volume in one second < 50% of prediction. Clinical data of the patients were retrospectively reviewed.

The patients consisted of 108 males (85.0%) and 19 females (15.0%) with a mean age of 61.7 years. The morbidity rate was 44.1% (56/127) and the mortality rate was 4.7% (6/127). Multivariate analysis identified PaCO2 (P = 0.023, OR = 2.959, 95%CI 1.164 - 7.522), the percent predicted postoperative diffusing capacity of the lung for carbon monoxide (P = 0.001, OR = 0.176, 95%CI 0.064 - 0.480) and comprehensive preoperative preparation (P = 0.048, OR = 0.417, 95%CI 0.176 - 0.993) as the independent predictors of postoperative cardiopulmonary complications that were found in 45 cases. Overall 1-, 3- and 5-year survival rates were 90%, 55% and 37% respectively. For overall survival, multivariate analysis revealed that TNM staging (P = 0.004, OR = 1.585, 95%CI 1.154 - 2.178) was the only independent prognostic factor.

On the premise of integrated preoperative evaluation and comprehensive preoperative preparation, major lung resection provides an optimal therapeutic for selected non-small cell lung cancer patients with compromised pulmonary function. Hypercapnea and the percent predicted postoperative diffusing capacity of the lung for carbon monoxide < 40% could be considered as the independent predictive factors for operative risk in those patients.