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Use the Lower Limit of Normal, Not 80% Predicted, in Judging Eligibility for Lung Resection
Stefan P Wesolowski1, Piotr W Boros, Tadeusz M Orłowski
1Departments of Lung Pathophysiology, National Tuberculosis and Lung Disease Research Institute, Warsaw, Poland.
Respiration; International Review of Thoracic Diseases
|July 19, 2016
Summary
Using the lower limit of normal (LLN) to define impaired lung function (LF) in lung cancer patients undergoing resection identifies fewer patients with respiratory impairment compared to the 80% predicted cutoff. This approach allows for safe surgery without extra testing.
Area of Science:
- Pulmonary Medicine
- Thoracic Surgery
- Respiratory Physiology
Background:
- Impaired lung function (LF) is a significant risk factor for perioperative complications in patients undergoing lung resection.
- Recent European guidelines suggest using values below 80% predicted to indicate abnormal LF, differing from the traditional lower limit of normal (LLN).
Purpose of the Study:
- To compare the impact of two cutoff points for defining impaired LF (80% predicted vs. LLN) on the incidence of functional disorders and postoperative complications.
- To evaluate these definitions in lung cancer patients undergoing lung resection surgery.
Main Methods:
- Retrospective analysis of preoperative spirometry and transfer factor for carbon monoxide (TL,CO) in 851 lung cancer patients.
- Comparison of LF indices below 80% predicted versus below the LLN (-1.645 SD).
Main Results:
- Airway obstruction was diagnosed in 43.4% and restrictive pattern in 4.8% of patients.
- LF indices were below LLN in 59.1% and below 80% predicted in 72.9% of patients (p < 0.0001).
- Using LLN identified 14% fewer patients with LF impairment compared to the 80% predicted cutoff, with no increased risk of complications.
Conclusions:
- Lung function impairments are prevalent in candidates for lung resection.
- Defining LF impairment by LLN reduces the diagnosed prevalence by 14% compared to the 80% predicted cutoff.
- Employing the LLN criterion enables safe resectional surgery without necessitating additional functional testing for a significant patient group.
