Ventilation defect burden predicts lung cancer resection outcomes

Abnormal ventilation prior to lung cancer resection has not been investigated using modern ventilation imaging modalities and may better predict postoperative outcomes than guideline-recommended lung function tests. Our objective was to quantify the burden of ventilation defects observed using Technegas single-photon emission computed tomography (SPECT) and ¹²⁹Xe magnetic resonance imaging (MRI) before lung cancer resection, and to evaluate their association with postoperative pulmonary complications and length of hospital stay.

This was a prospective, 6-week, observational study of adults undergoing lung cancer resection at a single centre. Before lung resection, participants underwent Technegas-SPECT, ¹²⁹Xe-MRI, spirometry and measurement of diffusing capacity of the lung for carbon monoxide. Preoperative ventilation defect burden was quantified by the Technegas-SPECT and ¹²⁹Xe-MRI ventilation defect percent (VDP). Predictors of complications during the 4-week postoperative period and length of hospital stay were evaluated by logistic and linear regression.

Abnormal ventilation was observed preoperatively by Technegas-SPECT and ¹²⁹Xe-MRI for 58% (60 of 103) and 73% (74 of 102) of participants, respectively. Preoperative VDPs were higher for participants with postoperative complications compared with those without (SPECT: p=0.01; MRI: p=0.0006) and correlated with length of hospital stay (SPECT: r=0.44, p<0.0001; MRI: r=0.51, p<0.0001). Multivariable models revealed preoperative VDP to be the strongest predictor of postoperative complications (SPECT: OR 1.06, 95% CI 1.01-1.11, p=0.02; MRI: OR 1.11, 95% CI 1.02-1.21, p=0.02) and length of hospital stay (SPECT: β=0.16, p<0.001; MRI: β=0.23, p<0.001).

Abnormal ventilation is prevalent prior to lung cancer resection and may be a stronger predictor of postoperative complications and length of hospital stay than standard clinical lung function measures.