Lung function predicts pulmonary complications regardless of the surgical approach

Although postoperative predicted forced expiratory volume in the first second and diffusing capacity of lung (ppoFEV1% and ppoDLCO%, respectively) have been identified as independent predictors of postoperative pulmonary complications after open lobectomy, it has been suggested that their predictive abilities may not extend to patients undergoing minimally invasive lobectomy.

We evaluated outcomes in 805 patients undergoing isolated lobectomy through open (n = 585) or minimally invasive approaches (n = 220) using a prospective database. Demographic and physiologic data were extracted and compared with complications classified as pulmonary, cardiac, other, mortality, and any.

Patients included 428 women and 377 men; mean age was 65.0 years. Minimally invasive patients were older (66.6 versus 64.3 years, p = 0.006), had better ppoFEV1% (71.5% versus 65.6%, p < 0.001) and performance status (0,1 94.1% versus 88.4%, p = 0.017), and less often underwent induction therapy (0.5% versus 4.8%, p = 0.003). Pulmonary and other complications were less common after minimally invasive lobectomy (3.6% versus 10.4%, p = 0.0034; 8.6% versus 15.8%, p = 0.008). Operative mortality occurred in 1.4% of minimally invasive patients and 3.9% of open patients (p = 0.075). Pulmonary complication incidence was related to predicted postoperative lung function for both minimally invasive and open approaches. On multivariate analysis with stratification for stage, ppoFEV1% and ppoDLCO% were predictive of pulmonary complications for both minimally invasive and open approaches.

Our results suggest that the predictive abilities of ppoFEV1% and ppoDLCO% are retained for minimally invasive lobectomy and can be used to estimate the risk of pulmonary complications.