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Use of the anatomical formulae for predicted postoperative (PPO) evaluation overestimates the loss of FEV1 and DLCO

Sara Degiovanni1, Sara Parini1, Guido Baietto1

  • 1Division of Thoracic Surgery, Azienda Ospedaliero-Universitaria Maggiore della Carità di Novara, Novara, Italy.

Journal of Thoracic Disease
|January 20, 2025
PubMed
Summary
This summary is machine-generated.

Anatomical formulas for predicting postoperative lung function are reliable for thoracotomy but overestimate FEV1 and DLCO loss after minimally invasive surgery (MIS). This impacts patient selection for MIS lung cancer surgery.

Keywords:
Lung functionlobectomyrobotic-assisted thoracoscopic surgery (RATS)spirometryvideo-assisted thoracoscopic surgery (VATS)

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Area of Science:

  • Pulmonology
  • Thoracic Surgery
  • Oncology

Background:

  • Pulmonary function assessment is crucial before lung cancer surgery.
  • Predicted postoperative (PPO) values estimate residual lung function post-resection.
  • Minimally invasive surgery (MIS) is increasingly used for lung resections.

Purpose of the Study:

  • To evaluate the accuracy of anatomical formulae in estimating postoperative pulmonary function after MIS lung resection.
  • To compare PPO values derived from anatomical formulae with actual postoperative pulmonary function test (PFT) results.

Main Methods:

  • Retrospective study of lung cancer patients undergoing lobectomy or segmentectomy via MIS or thoracotomy.
  • Collected pre- and postoperative PFT data (FEV1, DLCO) up to 1 year after surgery.
  • Compared actual postoperative PFT values with PPO values calculated using anatomical formulae.

Main Results:

  • Anatomical formulae underestimated postoperative FEV1% by 8.65% in MIS patients (P<0.001).
  • A significant underestimation of 2.78% was observed for PPO DLCO% compared to actual DLCO% in MIS patients (P=0.045).
  • Formulae were reliable for thoracotomy but overestimated function loss in MIS.

Conclusions:

  • Current anatomical formulae are reliable for predicting postoperative lung function after thoracotomy.
  • These formulae tend to overestimate FEV1 and DLCO loss in MIS, potentially excluding eligible patients.
  • Revising prediction methods may be necessary for MIS lung cancer surgery.