Sublobar resection or lobectomy and postoperative respiratory complications in emphysematous lungs
Kentaro Miura, Shogo Ide, Masatoshi Minamisawa, Shuji Mishima, Shunichiro Matsuoka, Takashi Eguchi, Kazutoshi Hamanaka, Kimihiro Shimizu- Cardiology and Cardiovascular Medicine
- Pulmonary and Respiratory Medicine
- General Medicine
- Surgery
Abstract
OBJECTIVES
Pulmonary resection in patients with severe emphysema may impact postoperative respiratory complications. Low attenuation areas evaluated using three-dimensional computed tomography to assess emphysematous changes are strongly associated with postoperative respiratory complications. Herein, we investigated the relationship between low attenuation area, the surgical procedure, and resected lung volume, which has not been explored in previous studies.
METHODS
We retrospectively evaluated patients with primary or metastatic lung cancer who underwent surgical resection. The low-attenuation area percentage (low attenuation area/total lung area × 100) and resected lung volume were calculated using three-dimensional computed tomography software, and the relationship with postoperative respiratory complications was analyzed.
RESULTS
Postoperative respiratory complications occurred in 66 patients (17%) in the total cohort (n = 383). We set the median value of 1.1% as the cut-off value for low-attenuation area percentage to predict postoperative respiratory complications, which occurred in 24% and 10% of patients with low attenuation area >1.1% and <1.1%, respectively (P < 0.001). Postoperative respiratory complications occurred in approximately one-third of the patients with low attenuation area >1.1%, whose resected lung volume was ≥15.8% or ≥ 5 resected subsegments. Multivariable analysis revealed that sublobar resection was associated with a significantly lower risk of postoperative respiratory complications in patients with low attenuation area >1.1% (odds ratio: 0.4, 95% confidence interval: 0.183–0.875).
CONCLUSIONS
Emphysema is a risk factor for postoperative respiratory complications, and lobectomy is an independent predictive risk factor. Preserving more lung parenchyma may yield better short-term prognoses in patients with emphysematous lungs.