Smoking is a perioperative risk factor and prognostic factor for lung cancer surgery

Smoking and Complications After Cancer Surgery: A Systematic Review and Meta-Analysis

Importance

Surgical cancer treatments may be delayed for patients who smoke over concerns for increased risk of complications. Quantifying risks for people who had recently smoked can inform any trade-offs of delaying surgery.

Objective

To investigate the association between smoking status or smoking cessation time and complications after cancer surgery.

Data Sources

Embase, CINAHL, Medline COMPLETE, and Cochrane Library were systematically searched for studies published from January 1, 2000, to August 10, 2023.

Study Selection

Observational and interventional studies comparing the incidence of complications in patients undergoing cancer surgery who do and do not smoke.

Data Extraction and Synthesis

Two reviewers screened results and extracted data according to the Meta-Analyses of Observational Studies in Epidemiology (MOOSE) reporting guidelines. Data were pooled with a random-effects model and adjusted analysis was performed.

Main Outcomes and Measures

The odds ratio (OR) of postoperative complications (of any type) for people who smoke currently vs in the past (4-week preoperative cutoff), currently smoked vs never smoked, and smoked within shorter (2-week cutoff) and longer (1-year cutoff) time frames.

Results

The meta-analyses across 24 studies with a pooled sample of 39 499 participants indicated that smoking within 4 weeks preoperatively was associated with higher odds of postoperative complications compared with ceasing smoking for at least 4 weeks (OR, 1.31 [95% CI, 1.10-1.55]; n = 14 547 [17 studies]) and having never smoked (OR, 2.83 [95% CI, 2.06-3.88]; n = 9726 [14 studies]). Within the shorter term, there was no statistically significant difference in postoperative complications between people who had smoked within 2 weeks preoperatively and those who had stopped between 2 weeks and 3 months in postoperative complications (OR, 1.19 [95% CI, 0.89-1.59]; n = 5341 [10 studies]), although the odds of complications among people who smoked within a year of surgery were higher compared with those who had quit smoking for at least 1 year (OR, 1.13 [95% CI, 1.00-1.29]; N = 31 238 [13 studies]). The results from adjusted analyses were consistent with the key findings.

Conclusions and Relevance

In this systematic review and meta-analysis of smoking cessation and complications after cancer surgery, people with cancer who had stopped smoking for at least 4 weeks before surgery had fewer postoperative complications than those smoking closer to surgery. High quality, intervention-based evidence is needed to identify the optimal cessation period and inform clinicians on the trade-offs of delaying cancer surgery.

Relationship between gender and perioperative clinical features in lung cancer patients who underwent VATS lobectomy

OBJECTIVES

Compare the differences in perioperative clinical characteristics of lung cancer patients of different genders who have undergone VATS lobectomy, and explore the impact of these differences on the short-term prognosis of patients.

METHODS

A total of 338 consecutive patients with lung cancer who underwent VATS lobectomy in our hospital from August 2021 to August 2022 were retrospectively analyzed, they were divided into male group and female group. The perioperative characteristics and short-term prognosis of different groups were compared. The multivariate binary logistic regression analysis was used to analyze the risk factors.

RESULTS

There were statistically significant differences between male and female patients in age of onset, body surface area (BSA), smoking rate, alcohol consumption rate, hypertension incidence, pulmonary function and clinical stage. There were statistically significant differences between male and female patients in operation time and lymph node dissection. The probability of postoperative complications, such as pulmonary infection, persistent air leakage and severe subcutaneous emphysema, in male patients was significantly higher than that in female patients. The average daily postoperative thoracic drainage volume in male patients was considerably higher than that in female patients, and the postoperative duration of thoracic drainage tube and hospital stay in male patients were significantly longer than those in female patients. After multiple regression analysis, low FEVI values in males was found to be an independent risk factor for postoperative complications.

CONCLUSIONS

Compared with female patients, male patients with lung cancer are more likely to have unfavorable factors such as older age, higher smoking rate, poor pulmonary function and late clinical stage of tumors when they undergoing VATS surgery treatment. The appropriate thoracic drainage time can be selected according to gender differences to shorten the length of hospital stay. The incidence of postoperative complications is higher in male patients, especially those with poor pulmonary function, and active perioperative intervention is required to reduce the incidence of postoperative complications.

Salivary metabolites as potential predictive biomarkers for lung surgery complications: a retrospective cross-sectional study

PURPOSE

Saliva is often used as a tool for identifying systemic diseases because of the noninvasive nature of its collection. Moreover, salivary metabolites can be potential predictive factors for postoperative survival. We conducted the present study to establish whether salivary metabolites can function as predictive biomarkers for lung surgery complications.

METHODS

Unstimulated salivary samples were collected from 412 patients before lung surgery. Salivary metabolites were analyzed comprehensively by capillary electrophoresis mass spectrometry. Clinical data with the discriminatory ability of biomarkers were assessed to predict lung surgery complications using multivariate logistic regression analysis. The primary endpoint was the risk factors for postoperative complications of Clavien-Dindo grade ≥ III.

RESULTS

Postoperative complications of Clavien-Dindo grade ≥ III developed in 36 patients (8.7%). There was no postoperative 30-day mortality. Male sex (odds ratio [OR], 3.852; 95% confidence interval CI 1.455-10.199; p = 0.007) and salivary gamma-butyrobetaine (OR, 0.809; 95% CI 0.694-0.943; p = 0.007) were identified as significant risk factors for postoperative complications of Clavien-Dindo grade ≥ III.

CONCLUSION

Salivary metabolites are potential noninvasive biomarkers for predicting postoperative complications of lung surgery.

A dynamic nomogram predicting symptomatic pneumonia in patients with lung cancer receiving thoracic radiation

PURPOSE

The most common and potentially fatal side effect of thoracic radiation therapy is radiation pneumonitis (RP). Due to the lack of effective treatments, predicting radiation pneumonitis is crucial. This study aimed to develop a dynamic nomogram to accurately predict symptomatic pneumonitis (RP ≥ 2) following thoracic radiotherapy for lung cancer patients.

METHODS

Data from patients with pathologically diagnosed lung cancer at the Zhongshan People's Hospital Department of Radiotherapy for Thoracic Cancer between January 2017 and June 2022 were retrospectively analyzed. Risk factors for radiation pneumonitis were identified through multivariate logistic regression analysis and utilized to construct a dynamic nomogram. The predictive performance of the nomogram was validated using a bootstrapped concordance index and calibration plots.

RESULTS

Age, smoking index, chemotherapy, and whole lung V5/MLD were identified as significant factors contributing to the accurate prediction of symptomatic pneumonitis. A dynamic nomogram for symptomatic pneumonitis was developed using these risk factors. The area under the curve was 0.89(95% confidence interval 0.83-0.95). The nomogram demonstrated a concordance index of 0.89(95% confidence interval 0.82-0.95) and was well calibrated. Furthermore, the threshold values for high- risk and low- risk were determined to be 154 using the receiver operating curve.

CONCLUSIONS

The developed dynamic nomogram offers an accurate and convenient tool for clinical application in predicting the risk of symptomatic pneumonitis in patients with lung cancer undergoing thoracic radiation.

Risk analysis of grade ≥ 2 radiation pneumonitis based on radiotherapy timeline in stage III/IV non-small cell lung cancer treated with volumetric modulated arc therapy: a retrospective study

BACKGROUND

Radiotherapy is an important treatment for patients with stage III/IV non-small cell lung cancer (NSCLC), and due to its high incidence of radiation pneumonitis, it is essential to identify high-risk people as early as possible. The present work investigates the value of the application of different phase data throughout the radiotherapy process in analyzing risk of grade ≥ 2 radiation pneumonitis in stage III/IV NSCLC. Furthermore, the phase data fusion was gradually performed with the radiotherapy timeline to develop a risk assessment model.

METHODS

This study retrospectively collected data from 91 stage III/IV NSCLC cases treated with Volumetric modulated arc therapy (VMAT). Patient data were collected according to the radiotherapy timeline for four phases: clinical characteristics, radiomics features, radiation dosimetry parameters, and hematological indexes during treatment. Risk assessment models for single-phase and stepwise fusion phases were established according to logistic regression. In addition, a nomogram of the final fusion phase model and risk classification system was generated. Receiver operating characteristic (ROC), decision curve, and calibration curve analysis were conducted to internally validate the nomogram to analyze its discrimination.

RESULTS

Smoking status, PTV and lung radiomics feature, lung and esophageal dosimetry parameters, and platelets at the third week of radiotherapy were independent risk factors for the four single-phase models. The ROC result analysis of the risk assessment models created by stepwise phase fusion were: (area under curve [AUC]: 0.67,95% confidence interval [CI]: 0.52-0.81), (AUC: 0.82,95%CI: 0.70-0.94), (AUC: 0.90,95%CI: 0.80-1.00), and (AUC:0.90,95%CI: 0.80-1.00), respectively. The nomogram based on the final fusion phase model was validated using calibration curve analysis and decision curve analysis, demonstrating good consistency and clinical utility. The nomogram-based risk classification system could correctly classify cases into three diverse risk groups: low-(ratio:3.6%; 0 < score < 135), intermediate-(ratio:30.7%, 135 < score < 160) and high-risk group (ratio:80.0%, score > 160).

CONCLUSIONS

In our study, the risk assessment model makes it easy for physicians to assess the risk of grade ≥ 2 radiation pneumonitis at various phases in the radiotherapy process, and the risk classification system and nomogram identify the patient's risk level after completion of radiation therapy.

Perioperative considerations for cancer patients with obesity: A narrative review

Cancer in patients with obesity has become increasingly common throughout much of the world. Based on our experiences in a specialized cancer center, we have developed a set of standards and expectations that should streamline the surgical journey for this patient population. These recommendations should inform the perioperative management of oncology patients with obesity and help raise awareness of this critical and under-discussed topic.

Impact of smoking status and chronic obstructive pulmonary disease on pulmonary complications post lung cancer surgery

Introduction

Smoking and chronic obstructive pulmonary disease (COPD) are associated with an increased risk of post-operative pulmonary complications (PPCs) following lung cancer resection. It remains unclear whether smoking cessation reduces this risk.

Methods

Retrospective review of a large, prospectively collected database of over 1000 consecutive resections for lung cancer in a quaternary lung cancer centre over a 23-year period.

Results

One thousand and thirteen patients underwent curative-intent lobectomy or pneumonectomy between 1995 and 2018. Three hundred and sixty-two patients (36%) were ex-smokers, 314 (31%) were current smokers and 111 (11%) were never smokers. A pre-operative diagnosis of COPD was present in 57% of current smokers, 57% of ex-smokers and 20% of never smokers. Just over 25% of patients experienced a PPC. PPCs were more frequent in current smokers compared to never smokers (27% vs 17%, p = 0.036), however, no difference was seen between current and ex-smokers (p = 0.412) or between never and ex-smokers (p = 0.113). Those with a diagnosis of COPD, independent of smoking status, had a higher frequency of both PPCs (65% vs 35%, p<0.01) and overall complications (60% vs 40%, p<0.01) as well as a longer length of hospital stay (10 vs 9 days, p<0.01).

Conclusion

Smoking and COPD are both associated with a higher rate of PPCs post lung cancer resection. COPD, independent of smoking status, is also associated with an increased overall post-operative complication rate and length of hospital stay. An emphasis on COPD treatment optimisation, rather than smoking cessation in isolation, may help improve post-operative outcomes.

The prognostic value of decrease in prognostic nutritional index in stage III non-small cell lung cancer patients during curative thoracic radiotherapy

BACKGROUND

Curative thoracic radiotherapy (CTRT) with concurrent chemotherapy has been considered as standard treatment approach for stage-III non-small cell lung cancer (NSCLC). The hematological and esophageal toxicities that have been encountered during CTRT would affect the immunonutritional status of the patients. The aim of this study is to evaluate the prognostic value of the change in pre- and post-treatment prognostic nutritional index (PNI) in stage-III NSCLC patients.

METHODS

Eighty seven consecutive stage III NSCLC patients' data were collected. Pre-radiotherapy (RT) and post-RT PNI values were calculated and the impact of prognostic value of PNI change on overall survival (OS) was evaluated by univariate and multivariate Cox regression analyses. A cutoff value of PNI change was obtained by receiver operator characteristic (ROC) curve analysis.

RESULTS

The cutoff value was found to be a 22% decrease in PNI by ROC curve analysis in terms of effect on OS. The median OS of low and high PNI decrease groups were 22.5 and 16.5 months respectively (P = 0,001). In univariate and multivariate analyses PNI decrease of ≥ 22% was found to be an independent poor prognostic factor for OS (P = 0.012) and hazard ratio (95% confidence interval)= 2.05 (1.16-3.62).

CONCLUSION

The PNI change would be a convenient parameter to assess the immunonutritional status of the patient at the end of CTRT. A decrease of more than 22% of PNI value may predict poor prognosis.

Variability in Smoking Status for Lobectomy Among Society of Thoracic Surgeons Database Participants

BACKGROUND

Current smokers undergoing lobectomy are at greater risk of complications than are former smokers. The Society of Thoracic Surgeons (STS) composite score for rating program performance for lobectomy adjusts for smoking status, a modifiable risk factor. This study examined variability in the proportion of current smokers undergoing lobectomy among STS database participants. Additionally, the study determined whether each participant's rating changed if smoking was excluded from the risk adjustment model.

METHODS

This is a retrospective analysis of the STS cohort used to develop the composite score for rating program performance for lobectomy. The study summarized the variability among STS database participants for performing lobectomy on current smokers and compared star ratings developed from models with and without smoking status.

RESULTS

There were 24,912 patients with smoking status data: 23% current smokers, 62% former smokers, and 15% never smokers. There was significant variability among participants in the proportion of current smokers undergoing lobectomy (3% to 48.6%; P < .001). Major morbidity or mortality (composite) was greater in current smokers (12.1%) than in former smokers (8.6%) and never smokers (4.2%) (P < .001). Using the current risk adjustment model, participant star ratings were as follows: 1 star, n = 6 (3.2%); 2 stars, n = 170 (91.4%); and 3 stars, n = 10 (5.4%). When smoking status was excluded from the model, 1 participant shifted from a 2-star to a 3-star program.

CONCLUSIONS

There is substantial variability among STS database participants with regard to the proportion of current smokers undergoing lobectomy. However, exclusion of smoking status from the model did not significantly affect participant star rating.

Correlation Between Smoking Status and Short-term Outcome of Thoracoscopic Surgery for Lung Cancer

BACKGROUND

Smoking has a major role in the risk of postoperative pulmonary complications. This study aimed to elucidate the correlation between smoking status and pulmonary complications after thoracoscopic surgery for lung cancer.

METHODS

A total of 1751 patients who underwent thoracoscopic lobectomy or segmentectomy for lung cancer between April 2011 and March 2020 were assessed. The rate of pulmonary complications was evaluated according to smoking status and preoperative duration of smoking cessation. Univariate and multivariate logistic regression analyses were performed.

RESULTS

Pulmonary complications were observed in 50 patients (2.9%), whereas 3 (0.2%) died within 90 days of surgery. The rate of pulmonary complications was higher in smokers than in nonsmokers (4.6% vs 0.9%; P < .001), and smoking history was an independent risk factor for pulmonary complications (odds ratio, 3.31; P = .007). The complication rate in patients with a cessation period of more than 2 months was significantly lower than that in patients who ceased smoking within 2 months (4.0% vs 8.5%; P = .043), but it was still higher than that in nonsmokers (4.0% vs 0.9%; P < .001). In the multivariable analysis for smokers, preoperative short-term smoking cessation within 2 months, male sex, histologic type, tumor size, and cardiopulmonary comorbidities were associated with pulmonary complications instead of pack-year smoking history.

CONCLUSIONS

Smoking habits and preoperative smoking cessation were independently associated with pulmonary complications after thoracoscopic surgery for lung cancer. A preoperative smoking cessation period of 2 months or more is preferable for reducing the risk of such complications.

Prognostic Impact of Smoking Period in Patients with Surgically Resected Non-small Cell Lung Cancer

BACKGROUND

The pack-year index, which is calculated by multiplying a smoking period by the number of cigarette packs smoked per day, is frequently used to investigate the risk of developing lung cancer. Notably, however, whether the smoking period or the number of packs per day is more predictive of postoperative prognosis remains unclear in non-small cell lung cancer (NSCLC) patients who receive curative lung resection.

PATIENTS AND METHODS

Initial screening included 2055 consecutive lung cancer patients who had underwent curative lung resection between 2000 and 2016 at a single center in Japan. Data from 1134 NSCLC patients with smoking history were ultimately analyzed. Time-dependent areas under the curve (AUCs) were used to compare diagnostic accuracy.

RESULTS

On univariate analysis, the number of packs smoked per day was not a significant predictor of disease-free survival (DFS; p = 0.2387) or overall survival (OS; p = 0.1357). On multivariable analysis, smoking period was an independent predictor of DFS and OS (both p < 0.0001). Time-dependent smoking period AUCs were superior to those of number of packs smoked per day. On subgroup analyses, patients with a smoking period ≥ 40 years had significantly shorter DFS and OS than those with a smoking period of < 40 years, independent of sex, clinical stage, and histological type.

CONCLUSIONS

Smoking period was a significant prognostic indicator in NSCLC patients who underwent curative lung resection, which should be validated in further prospective and/or multicenter studies with large sample sizes.

Preoperative Smoking Cessation Period Is Not Related to Postoperative Respiratory Complications in Patients Undergoing Lung Cancer Surgery

PURPOSE

Smoking is reported to be a risk factor for postoperative complications. However, there is no consensus regarding the length of time for which patients need to give up smoking. Therefore, we examined the relationship between preoperative smoking status and postoperative complications in patients who underwent lobectomy for treatment of lung cancer.

METHODS

Between January 2009 and December 2014, 1380 patients underwent lobectomy for lung cancer at our institution. After excluding patients who had undergone induction therapy, 1248 patients were enrolled in this study. We examined the relationship between postoperative complications and preoperative smoking habitation.

RESULTS

Among the enrolled patients, 1210 (97%) underwent video-assisted thoracoscopic lobectomy and 38 (3%) underwent lobectomy via open thoracotomy. The incidence of postoperative complications was higher in smokers than in nonsmokers, and the frequency of respiratory-related complications increased along with the number of pack-years. However, there was no relationship between the length of the preoperative smoking cessation period and the frequency of postoperative complications.

CONCLUSION

The risk of postoperative complications does not increase even if smoking is continued within 2 weeks before surgery. It seems unnecessary to delay the timing of surgery to allow patients to cease smoking, especially those scheduled for thoracoscopic surgery.

Relationship between pain outcomes and smoking history following video-assisted thoracic surgery for lobectomy: a retrospective study

Purpose

The relationship between chronic smoking history and postoperative pain remains controversial. This study aimed to elucidate this relationship in non-small cell lung cancer (NSCLC) patients who underwent video-assisted thoracic surgery (VATS) lobectomy.

Patients and methods

This retrospective observational study included NSCLC patients treated with VATS lobectomy between January 2011 and July 2017. Demographic and clinical information, including preoperative smoking history, was collected. The primary goal was to investigate the relationship between smoking history and postoperative pain outcomes (oral morphine equivalent [OME] consumption and pain score). Multivariate linear regression analysis was performed, and P<0.05 was considered as statistically significant.

Results

A total of 1,785 patients were included in the final analysis. Multivariate linear regression analysis revealed that total smoking amount (in packs), status as current smoker, and cessation time did not have an association with OME consumption (mg) or pain scores on postoperative days 0–2 (P>0.05). However, patients who had never smoked consumed less morphine equivalent analgesics (mg) on postoperative days 0–2 (coefficient: −17.48, 95% CI [−33.83, −1.13], P=0.036) compared to patients who had a history of smoking.

Conclusion

Patients who had never smoked had lower opioid analgesics consumption on the days immediately following surgery, while being a current smoker or the total amount of smoking in packs did not affect postoperative pain outcomes after VATS lung lobectomy.

[Analysis of Postoperative Complications and Risk Factors of Patients with Lung Cancer through Clavien-Dindo Classification]

背景与目的

术后并发症是肺切除术后患者死亡的重要原因。在本研究中，我们应用Clavien-Dindo并发症分级系统对肺癌术后并发症按照严重程度进行分级，并分析术后并发症的发生率，探讨不同分级术后并发症的危险因素。

方法

回顾性分析2013年6月-2014年12月四川大学华西医院胸外科966例行肺叶切除术的肺癌患者，依据术后30 d内是否发生并发症将此966例患者分为并发症组与无并发症组；同时根据Clavien-Dindo分级系统将并发症分为4级，并针对不同分级的并发症进行危险因素分析。

结果

966例患者中，并发症组占15.0%（145/966），发生总数380次；依据Clavien-Dindo分级系统将此380次并发症进行分级，其中Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级及以上分别占6.8%、75.3%、15.0%和2.9%。Logistic回归分析结果显示术前第1秒用力呼气容积（forded expiratory volume in one second, FEV₁）、肺一氧化碳弥散量（diffusion capacity for carbon monoxide of the lung single breath, DLco SB）及术前合并慢性阻塞性肺疾病（chronic obstructive pulmonary disease, COPD）是术后并发症的独立危险因素；其中术前FEV₁是Ⅰ级、Ⅱ级、Ⅲ级及以上并发症的独立危险因素。

结论

在Clavien-Dindo分级系统下，Ⅱ级并发症在术后30天内最常见；FEV₁与术后并发症的发生密切相关，可作为评估术后并发症发生风险的可靠指标之一。

Clinical Significance of Prognostic Nutritional Index After Surgical Treatment in Lung Cancer

BACKGROUND

The prognostic nutritional index (PNI), calculated as 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (cells/mm³), can reportedly predict postoperative complications and prognosis for various types of malignancy. However, the clinical significance and prognostic value of the PNI for both short- and long-term outcomes remains uncertain in patients with lung cancer.

METHODS

We retrospectively reviewed 248 patients with completely resected non-small cell lung cancer (NSCLC). Clinicopathologic characteristics were evaluated according to the PNI, and the prognostic significance for postoperative outcomes was assessed using Cox proportional regression analysis. The survival rate was calculated using the Kaplan-Meier method.

RESULTS

An optimal cutoff of 48 for recurrence-free survival (RFS) was determined using the minimum p value approach. Old age, low body mass index, large tumor size, and elevated C-reactive protein levels correlated significantly with low PNI. Logistic regression analysis demonstrated that low PNI status was statistically related to postoperative complications (Clavien-Dindo grade ≥II) and pulmonary air leakage. Five-year overall survival (OR) rates in the high- and low-PNI groups were 80.6% and 58.5%, respectively (p = 0.002). Five-year RFS rates were 73.6% and 48.6%, respectively (p < 0.001). Furthermore, PNI was identified as an independent prognostic factor for OS (hazard ratio [HR], 2.18; 95% confidence interval [CI], 1.08-4.21) and RFS (HR, 2.57; 95% CI, 1.46-4.38) by multivariate analysis.

CONCLUSIONS

The PNI could represent a useful biomarker to predict postoperative complications and survival in patients with completely resected NSCLC.

Preoperative management using inhalation therapy for pulmonary complications in lung cancer patients with chronic obstructive pulmonary disease

Objective

This study aimed to investigate whether perioperative inhalations of long-acting beta-agonists (LABAs) or long-acting muscarinic antagonists (LAMAs) might decrease the incidence of postoperative complications in lung cancer patients with chronic obstructive pulmonary disease (COPD).

Methods

We retrospectively analyzed 108 patients with COPD who underwent pulmonary resections for primary lung cancer at our hospital between January 2013 and January 2016 to determine the association between the incidence of postoperative complications (e.g., prolonged air leakage and pneumonia) and the use of LABAs or LAMAs.

Results

Thirty patients with COPD experienced postoperative complications (27.8%): Fourteen patients had prolonged air leakages (more than 7 days), ten patients developed pneumonia. The frequency of these postoperative pulmonary complications was significantly higher among the patients with COPD (24/108 cases, 22.2%), compared with the frequency among non-COPD patients (15/224 cases, 6.7%). Inhaled bronchodilators, such as LAMA or LABA, were prescribed for 34 of the 108 patients with COPD; the remaining 74 patients were not treated with bronchodilators. Pulmonary complications were significant lower among the LAMA or LABA users (3/34 cases, 8.8%) than among the untreated COPD patients (21/74 cases, 28.4%).

Conclusion

For lung cancer patients with COPD, preoperative management using LABA or LAMA bronchodilators and smoking cessation can reduce the frequency of postoperative pulmonary complications after surgical lung resection. LAMA or LABA inhalation might be useful for not only perioperative care, but also for the long-term survival of COPD patients after surgery.

[Status of perioperative airway management in patients with chronic obstructive pulmonary disease and lung cancer]

肺癌患者均合并不同程度的慢性阻塞性肺疾病（chronic obstructive pulmonary disease, COPD），而COPD导致的肺功能降低对其能否手术治疗及术后并发症发生具有重要的影响。研究证明围手术期气道管理可以有效改善患者肺功能且减少术后并发症。本文针对近年来气道管理的临床应用现状及进展进行综述，主要有以下几方面：①围手术期气道管理的必要性；②围手术期气道管理的药物治疗现状与特点；③围手术期应用气道管理在改善肺功能中的价值；④围手术期需要气道管理的最佳人群；⑤围手术期气道管理应用存在的问题。

Nondosimetric risk factors for radiation-induced lung toxicity

The decision to administer a radical course of radiotherapy (RT) is largely influenced by the dose-volume metrics of the treatment plan, but what are the patient-related and other factors that may independently increase the risk of radiation lung toxicity? Poor pulmonary function has been regarded as a risk factor and a relative contraindication for patients undergoing radical RT, but recent evidence suggests that patients with poor spirometry results may tolerate conventional or high-dose RT as well as, if not better than, patients with normal function. However, caution may need to be exercised in patients with underlying interstitial pulmonary fibrosis. Furthermore, there is emerging evidence of molecular markers of increased risk of toxicity. This review discusses patient-related risk factors other than dosimetry for radiation lung toxicity.