Functional Stratification and Postoperative Outcomes in Endobronchial Tumor Surgery: A Dedicated Center Experience

Area of Science:

• Thoracic surgery
• Pulmonary medicine
• Cardiopulmonary exercise testing

Background:

• Endobronchial tumors present diverse histopathological types, posing challenges in surgical strategy selection.
• Multidisciplinary assessment is crucial for optimizing treatment plans for these tumors.

Purpose of the Study:

• To evaluate the integration of spirometry, diffusion capacity of the lungs for carbon monoxide (DLCO), and cardiopulmonary exercise testing (CPET) for cardiorespiratory risk stratification.
• To guide surgical decision-making regarding resection type, postoperative complications, and perioperative mortality in patients with endobronchial tumors.

Main Methods:

• Retrospective analysis of 93 patients with endobronchial masses undergoing preoperative evaluation (spirometry, DLCO, CPET, cardiology assessment, CT, AFB).
• Patients were categorized based on multidisciplinary tumor board review and surgical intervention (sleeve resection, lobectomy, bilobectomy, pneumonectomy).

Main Results:

• Advanced age and higher ASA scores correlated with reduced preoperative DLCO (p < 0.0001).
• Overall morbidity was 36.84% and mortality was 5.26%.
• Complication rates increased significantly with surgical magnitude: sleeve resections (17.6%) to pneumonectomies (60.0%; p = 0.042). Severe morbidity was lower in sleeve resections (5.8%) vs. pneumonectomies (40.0%; p = 0.015).

Conclusions:

• A multi-parametric preoperative protocol aids risk stratification for endobronchial tumor surgery.
• The anatomical and hemodynamic magnitude of pneumonectomy is an independent risk modifier not fully captured by functional testing alone.