Exercise ventilatory inefficiency and mortality in patients with chronic obstructive pulmonary disease undergoing surgery for non-small-cell lung cancer

• DOI: 10.1016/j.ejcts.2010.01.032
• Publication Date: 2010-03-31T04:51:27Z
• Authors: Roberto Torchio; Marco Guglielmo; Roberto Giardino; Francesco Ardissone; Claudio Ciacco; Carlo Gulotta; Aleksandar Veljkovic; Massimiliano Bugiani
• Keywords: Lung cancer surgery

Surgical resection is the treatment of choice to cure patients with non-small-cell lung cancer (NSCLC); nevertheless, assessment lower limit surgical tolerance remains difficult. Ventilatory inefficiency (measured as ventilation CO(2) production ratio (V'(E)/V'(CO2) slope) a survival predictor in pulmonary hypertension (PH) and chronic heart failure (CHF) considered marker PH obstructive disease (COPD). The aim this study was investigate role V'(E)/V'(CO2) slope preoperative mortality morbidity COPD submitted for NSCLC operable according current standards.A retrospective analysis performed 145 consecutive (128 males 17 females), mean age 64 years (range: 41-82 years) who were referred preoperatory evaluation. Because bronchial obstruction or reduced diffusion capacity carbon monoxide (D(L,CO)), all these only after cardiopulmonary exercise test showed preserved function.A total 98 lobectomies, eight bilobectomies 39 pneumonectomies (13 left 26 right) performed. Twenty-one (14.5%) suffered severe cardio-respiratory complications; 15/106 (14.2%) lobectomy/bilobectomy 6/39 (15.4%) pneumonectomy. Five (3.4%) died within 30 days surgery (3/106 (2.8%) 2/39 pneumonectomy (5.1%)). Considering functional parameters before postoperative predicted values, logistic regression individuated independent (odds (OR): 1.24 z=2.77; p<0.007). V'(O2 peak) instead best occurrence complications (OR: 0.05, z=-2.39, p<0.02).In patients, high an even presence acceptable performance. must be carefully screened exclude hypertension, especially procedures large parenchymal exeresis.