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A New Functional Threshold for Minimally Invasive Lobectomy.

Stijn Vanstraelen1, Kay See Tan2, Joe Dycoco1

  • 1Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.

Annals of Surgery
|May 10, 2024
PubMed
Summary
This summary is machine-generated.

A lower threshold of predicted postoperative forced expiratory volume in 1 second/diffusion capacity of the lung for carbon monoxide (ppoFEV 1 /ppoDLCO) <45% better predicts complications after minimally invasive surgery lobectomy. Updated guidelines are needed for accurate risk assessment.

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Area of Science:

  • Thoracic Surgery
  • Pulmonary Medicine
  • Surgical Oncology

Background:

  • Minimally invasive surgery (MIS) lobectomy offers better outcomes than open surgery but often uses risk algorithms developed for open procedures.
  • Current risk assessment for MIS lobectomy may be suboptimal due to varying definitions of cardiopulmonary complications.
  • There is a need to refine predictive models for postoperative complications in MIS lobectomy.

Purpose of the Study:

  • To evaluate the efficacy of a lower predicted postoperative (ppo) forced expiratory volume in 1 second/diffusion capacity of the lung for carbon monoxide (ppoFEV 1 /ppoDLCO) threshold (<45%) in predicting cardiopulmonary complications following MIS lobectomy.
  • To compare the performance of the <45% ppoFEV 1 /ppoDLCO threshold against the current guideline threshold of <60%.

Main Methods:

  • Analysis of 946 patients who underwent MIS lobectomy for clinical stage I to II lung cancer between 2018 and 2022.
  • Comparison of the predictive performance of a ppoFEV 1 /ppoDLCO threshold of <45% versus <60% for cardiopulmonary complications.
  • Evaluation of three different definitions for cardiopulmonary complications: STS, ESTS, and Berry et al.

Main Results:

  • The ppoFEV 1 /ppoDLCO threshold of <45% demonstrated superior classification accuracy (79%) compared to the <60% threshold (65%) (P <0.001).
  • Prolonged air leak was the most significantly different complication between the ppoFEV 1 /ppoDLCO thresholds of 45%-60% and >60% (13% vs 6%; P <0.001).
  • The Society of Thoracic Surgeons (STS) definition resulted in higher predicted complication probabilities across ppoFEV 1 and ppoDLCO values compared to ESTS or Berry definitions.

Conclusions:

  • A ppoFEV 1 /ppoDLCO threshold of <45% provides more accurate risk stratification for cardiopulmonary complications after MIS lobectomy.
  • The findings highlight the necessity for updated risk-assessment guidelines tailored to MIS lobectomy.
  • Optimizing cardiopulmonary function evaluation is crucial for improving patient outcomes after MIS lobectomy.