Postoperative pulmonary function changes according to the resected lobe: a 1-year follow-up study of lobectomized patients

Efficacy of digital therapeutics for perioperative management in patients with lung cancer: a randomized controlled trial

BACKGROUND

Perioperative management and lung function recovery are vital for lung cancer patients. We conducted an open-label, single-center, noninferiority, randomized controlled trial in China to evaluate the efficacy of digital therapeutic (DTx)-assisted management vs. multidisciplinary management (MM) in the perioperative management of patients with lung cancer.

METHODS

From July 2022 to June 2023, 186 minimally invasive lung surgery patients were randomized, and 147 completed the study. The participants were randomly assigned a 1:1 ratio to receive DTx-assisted management (n = 72) or traditional MM (n = 75). The primary endpoint was the pulmonary function recovery rate measured by forced expiratory volume in the first second (FEV1%) 3 weeks after surgery, and the noninferiority margin was set to 4.8%. The secondary endpoints included hospital stay duration, 90-day unplanned readmission rate, symptom scores, patient management time, and patient satisfaction rate. Exploratory endpoints include factors influencing postoperative lung function recovery.

RESULTS

The lung function FEV1% recovery rate of the DTx group was not inferior to that of the MM group (87.18% ± 11.01% vs. 84.21% ± 11.75%). There were no significant differences between the two groups in terms of postoperative hospitalization duration or 90-day unplanned readmission rates. The patient management time in the DTx group was significantly shorter than that in the MM group (1.48 ± 3.22 min vs. 16.67 ± 6.41 min, P < 0.001). Patient symptom scores tended to decrease over time after discharge, and the 5 target symptoms included pain, coughing, shortness of breath, disturbed sleep, and fatigue. On the 7th day after discharge, the DTx group had a lower occurrence rate of the 5 target symptoms triggering the alert threshold compared to the MM group (P = 0.002). Patients with higher education levels achieved a better FEV1% recovery rate with DTx-assisted management (P = 0.021).

CONCLUSIONS

Compared with the MM group, the DTx group achieved noninferior results in all evaluated clinically meaningful endpoints but was significantly more efficient in perioperative management, providing an alternative digitalized management mode for patients with lung cancer surgery.

TRIAL REGISTRATION

ChiCTR2200064723.

Efficacy of a smartphone application assisting home-based rehabilitation and symptom management for patients with lung cancer undergoing video-assisted thoracoscopic lobectomy: a prospective, single-blinded, randomised control trial (POPPER study)

BACKGROUND

Video-assisted thoracoscopic (VATS) lobectomy can affect patients' pulmonary function and quality of life significantly. No optimal protocol combining patient-reported outcome-based symptom management and postdischarge rehabilitation programme has yet been established. This study aimed to assess the efficacy of a novel smartphone app designed for home-based symptom management and rehabilitation.

METHODS

The app was developed based on three modules: a symptom reporting system with alerts, aerobic and respiratory training exercises, and educational material. Four core symptoms were selected based on a questionnaire survey of 201 patients and three rounds of Delphi voting by 30 experts. The authors screened 265 patients and randomly assigned 136 equally to the app group and usual care group. The primary outcome was pulmonary function recovery at 30 days postoperatively. Secondary outcomes included symptom burden and interference with daily living (both rated using the MD Anderson Symptom Inventory for Lung Cancer), aerobic exercise intensity, emergency department visits, app-related safety, and satisfaction with the app.

FINDINGS

Of the 136 participants, 56.6% were women and their mean age was 61 years. The pulmonary function recovery ratio 1 month after surgery in the app group was significantly higher than that in the usual care group (79.32 vs. 75.73%; P =0.040). The app group also recorded significantly lower symptom burden and interference with daily living scores and higher aerobic exercise intensity after surgery than the usual care group. Thirty-two alerts were triggered in the app group. The highest pulmonary function recovery ratio and aerobic exercise intensity were recorded in those patients who triggered alerts in both groups.

INTERPRETATION

Using a smartphone app is an effective approach to accelerate home-based rehabilitation after VATS lobectomy. The symptom alert mechanism of this app could optimise recovery outcomes, possibly driven by patients' increased self-awareness.

Compensatory function change by segment-counting method in predicted postoperative pulmonary function at 1 year after surgery: systematic review and meta-analysis

BACKGROUND

This systematic review aimed to assess the accuracy of the segment-counting method in predicting long-term pulmonary function recovery and investigate compensatory changes following different extents of lung resection.

METHODS

We included studies that measured forced expiratory volume at 1 s (FEV1) between 6 and 18 months postoperatively, comparing it to the predicted postoperative FEV1 (ppoFEV1) using the segment-counting method. The extent of lung resection was correlated with the ratio of postoperative FEV1 to ppoFEV1. A comprehensive search was conducted in Embase, MEDLINE and Web of Science using terms related to 'lung resection' and 'pulmonary function'. The final search was completed on 18 February 2022. Risk of bias was assessed using the Newcastle-Ottawa Scale.

RESULTS

39 studies comprising 78 observation cohorts met the inclusion criteria. The analysis showed significant differences in pulmonary function in patients with ≥3 resected segments. Meta-regression indicated that the number of resected segments significantly impacted the postoperative FEV1/ppoFEV1 ratio, explaining 57% of the variance (R²=0. 57), with moderate heterogeneity (I²=61. 87%) across studies. Other variables, including patient age, body mass index, video-assisted thoracoscopic surgery use and tumour stage, did not show significant effects.

DISCUSSION

Limitations of the review included moderate heterogeneity between studies and potential selection bias related to the stage of cancer and lung volume reduction effects. The findings suggest that the extent of lung resection correlates with better-than-expected pulmonary function, potentially due to compensatory mechanisms.

PROSPERO REGISTRATION NUMBER

This review was registered on PROSPERO (CRD42021293608).

Clinical Factors Affecting Discrepancy Between Predicted and Long-term Actual Lung Function Following Surgery

PURPOSE

Lung cancer surgery outcomes depend heavily on preoperative pulmonary reserve, with forced expiratory volume in 1 second (FEV1) being a critical preoperative evaluation factor. Our study investigates the discrepancies between predicted and long-term actual postoperative lung function, focusing on clinical factors affecting these outcomes.

METHODS

This retrospective observational study encompassed lung cancer patients who underwent preoperative lung perfusion SPECT/CT between 2015 and 2021. We evaluated preoperative and postoperative pulmonary function tests, considering factors such as surgery type, resected volume, and patient history including tuberculosis. Predicted postoperative lung function was calculated using SPECT/CT imaging.

RESULTS

From 216 patients (men:women, 150:66; age, 67.9 ± 8.7 years), predicted postoperative FEV1% (ppoFEV1%) showed significant correlation with actual postoperative FEV1% ( r = 0.667; P < 0.001). Paired t test revealed that ppoFEV1% was significantly lower compared with actual postoperative FEV1% ( P < 0.001). The study identified video-assisted thoracic surgery (VATS) (odds ratio [OR], 3.90; 95% confidence interval [CI], 1.98-7.69; P < 0.001) and higher percentage of resected volume (OR per 1% increase, 1.05; 95% CI, 1.01-1.09; P = 0.014) as significant predictors of postsurgical lung function improvement. Conversely, for the decline in lung function postsurgery, significant predictors included lower percentage of resected lung volume (OR per 1% increase, 0.92; 95% CI, 0.86-0.98; P = 0.011), higher preoperative FEV1% (OR, 1.03; 95% CI, 1.01-1.07; P = 0.009), and the presence of tuberculosis (OR, 5.19; 95% CI, 1.48-18.15; P = 0.010). Additionally, in a subgroup of patients with borderline lung function, VATS was related with improvement.

CONCLUSIONS

Our findings demonstrate that in more than half of the patients, actual postsurgical lung function exceeded predicted values, particularly following VATS and with higher volume of lung resection. It also identifies lower resected lung volume, higher preoperative FEV1%, and tuberculosis as factors associated with a postsurgical decline in lung function. The study underscores the need for precise preoperative lung function assessment and tailored postoperative management, with particular attention to patients with relevant clinical factors. Future research should focus on validation of clinical factors and exploring tailored approaches to lung cancer surgery and recovery.

Efficacy and safety of step-by-step Baduanjin exercise based on doctor-nurse-patient integration mode for pulmonary rehabilitation in patients after lobectomy due to pulmonary tuberculosis: a randomized controlled clinical trial

BACKGROUND

Some pulmonary tuberculosis patients may require lung resection surgery. Postoperative pulmonary rehabilitation is essential to restore the lung function and maintain quality of life. We aimed to study the pulmonary rehabilitation outcomes and complications of step-by-step Baduanjin exercise under a doctor-nurse-patient integration mode in patients after lobectomy due to pulmonary tuberculosis.

METHODS

We performed a randomized controlled clinical trial in patients undergoing lobectomy due to pulmonary tuberculosis between September 2017 and August 2021. Eligible patients were randomly assigned into the control group or interventional group. The control group received routine postoperative care. The interventional group received step-by-step Baduanjin exercise based on the doctor-nurse-patient integration mode in addition to the routine care. The primary outcomes were the pulmonary functions, including forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and FEV1/FVC. The secondary outcomes were the maximum walking distance in a 6-min walk test and postoperative pulmonary complications, including atelectasis, pneumonia, and respiratory failure.

RESULTS

A total of 100 patients were enrolled into the study, with 50 patients in the control and interventional groups. There were 60 female patients (60%). The mean patient age was 37.9 (± 2.8) years old. At the one- and two-month postoperative follow-ups, pulmonary function tests showed statistically significantly better performances in FEV1/prediction, FVC/prediction, and FEV1/FVC in the interventional group than the control group. The 6-min walk test also revealed longer walking distances in the interventional group than the control group. There were no statistically significant differences in postoperative complications between the two groups.

CONCLUSIONS

A step-by-step Baduanjin exercise regimen under the doctor-nurse-patient integration mode could safely improve pulmonary rehabilitation in patients after lobectomy due to pulmonary tuberculosis.

The Effects of Various Approaches to Lobectomies on Respiratory Muscle Strength, Diaphragm Thickness, and Exercise Capacity in Lung Cancer

BACKGROUND

The most common surgery for non-small cell lung cancer is lobectomy, which can be performed through either thoracotomy or video-assisted thoracic surgery (VATS). Insufficient research has examined respiratory muscle function and exercise capacity in lobectomy performed using conventional thoracotomy (CT), muscle-sparing thoracotomy (MST), or VATS. This study aimed to assess and compare respiratory muscle strength, diaphragm thickness, and exercise capacity in lobectomy using CT, MST, and VATS.

METHODS

The primary outcomes were changes in respiratory muscle strength, diaphragm thickness, and exercise capacity. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were recorded for respiratory muscle strength. The 6-min walk test (6MWT) was used to assess functional exercise capacity. Diaphragm thickness was measured using B-mode ultrasound.

RESULTS

The study included 42 individuals with lung cancer who underwent lobectomy via CT (n = 14), MST (n = 14), or VATS (n = 14). Assessments were performed on the day before surgery and on postoperative day 20 (range 17-25 days). The decrease in MIP (p < 0.001), MEP (p = 0.003), 6MWT (p < 0.001) values were lower in the VATS group than in the CT group. The decrease in 6MWT distance was lower in the MST group than in the CT group (p = 0.012). No significant differences were found among the groups in terms of diaphragmatic muscle thickness (p > 0.05).

CONCLUSION

The VATS technique appears superior to the CT technique in terms of preserving respiratory muscle strength and functional exercise capacity. Thoracic surgeons should refer patients to physiotherapists before lobectomy, especially patients undergoing CT. If lobectomy with VATS will be technically difficult, MST may be an option preferable to CT because of its impact on exercise capacity.

An analysis of residual lung volume changes after segmentectomy based on three-dimensional computed tomography

Background

Based on the results of JCOG0802 and CALGB studies, segmentectomy has considered to be a standard procedure for early-stage non-small cell lung cancer (NSCLC). After lobectomy, the residual cavity is filled with mediastinal and diaphragmatic deviations, and compensatory volume changes are present in the residual lungs. In this study, we examined the efficacy of segmentectomy, a surgical procedure, by focusing on its impact on postoperative lung volume and function.

Methods

We enrolled 77 patients who underwent segmentectomy as their initial surgical procedure, excluding those with additional lung resections and those who lacked postoperative computed tomography imaging. The predicted residual volume (mL) was defined as the total lung volume before surgery minus the volume of the resected area. Using the predicted residual volume (mL) and postoperative total lung volume (mL), we calculated the rate of postoperative lung volume increase [(postoperative total lung volume/predicted residual volume) × 100] (%). We also classified 52 cases with a rate of postoperative lung volume increase of ≥100% into a compensatory group, while those with a rate of <100% were classified into a non-compensatory group.

Results

The average postoperative lung volume increase was 104.6% among 77 cases. Age ≥65 years, pack year index ≥27.5, ≥3 resected segments, and use of electrocautery for intersegmental plane division were significantly associated with compensatory group classification. In 20 compensatory cases with preoperative and postoperative pulmonary function tests, postoperative vital capacity and forced expiratory volume in one second values exceeded the preoperative predictions. This study further examined the areas responsible for postoperative compensatory lung volume increase. In the compensatory group, significant expansion was observed in the ipsilateral lobes, excluding the resected segment and contralateral lung, while no significant changes were noted in the volume of the lobe, including the resected segment. Conversely, the non-compensatory group showed a significant volume decrease in the resected lobe, but no significant increase in other areas.

Conclusions

This study emphasizes the importance of preserving lung segments in segmentectomy. The study demonstrates extensive compensatory volume changes in the ipsilateral lung and contralateral lung. There was no significant volume decrease in any residual segment. This underlines the potential of segmentectomy to maintain lung function and expand treatment options post-surgery. In addition, the compensated group included patients with a lower pack-year index and younger patients. These results suggest that postoperative compensatory lung expansion includes not only hyperinflation of the remaining lung, but also an increase in the functional lung parenchyma.

Robust imaging approach for precise prediction of postoperative lung function in lung cancer patients prior to curative operation

BACKGROUND

To create a combined variable integrating both ventilation and perfusion as measured by preoperative dual-energy computed tomography (DECT), compare the results with predicted postoperative (PPO) lung function as estimated using conventional methods, and assess agreement with actual postoperative lung function.

METHODS

A total of 33 patients with lung cancer who underwent curative surgery after DECT and perfusion scan were selected. Ventilation and perfusion values were generated from DECT data. In the "combined variable method," these two variables and clinical variables were linearly regressed to estimate PPO lung function. Six PPO lung function parameters (segment counting, perfusion scan, volume analysis, ventilation map, perfusion map, and combined variable) were compared with actual postoperative lung function using an intraclass correlation coefficient (ICC).

RESULTS

The segment counting method produced the highest ICC for forced vital capacity (FVC) at 0.93 (p < 0.05), while the segment counting and perfusion map methods produced the highest ICC for forced expiratory volume in 1 second (FEV1 ; both 0.89, p < 0.05). The highest ICC value when using the combined variable method was for FEV1 /FVC (0.75, p < 0.05) and diffusing capacity of the lung for carbon monoxide (DLco; 0.80, p < 0.05) when using the perfusion map method. Overall, the perfusion map and ventilation map provided the best performance, followed by volume analysis, segment counting, perfusion scan, and the combined variable.

CONCLUSIONS

Use of DECT image processing to predict postoperative lung function produced better agreement with actual postoperative lung function than conventional methods. The combined variable method produced ICC values of 0.8 or greater for FVC and FEV1 .

Evaluation of preoperative cardiopulmonary reserve and surgical risk of patients undergoing lung cancer resection

Lung cancer represents the second most frequent neoplasm and the leading cause of neoplastic death among both women and men, causing almost 25% of all cancer deaths. Patients undergoing lung resection-both for primary and secondary tumors-require careful preoperative cardiopulmonary functional evaluation to confirm the safety of the planned resection, to assess the maximum tolerable volume of resection or to exclude surgery, thus shifting the therapeutic approach toward less invasive options. Cardiopulmonary reserve, pulmonary lung function and mechanical respiratory function represent the cornerstones of preoperative assessment of patients undergoing major lung resection. Spirometry with carbon monoxide diffusing capacity, split function tests, exercise tests and cardiologic evaluation are the gold standard instruments to safely assess the entire cardiorespiratory function before pulmonary resection. Although pulmonary mechanical and parenchymal function, together with cardiorespiratory compliance represent the mainstay of preoperative evaluation in thoracic surgery, the variables that are responsible for fitness in patients who have undergone lung resection have expanded and are being continually investigated. Nevertheless, because of the shift to older patients who undergo lung resection, a global approach is required, taking into consideration variables like frailty status and likelihood of postoperative functional deterioration. Finally, the decision to go ahead with surgery in fragile patients being consideredfor lung resection should be evaluated in a multispecialty preoperative discussion to provide a personalized risk stratification. The aim of this review is to focus on preoperative evaluation of cardiopulmonary reserve and surgical risk stratification of patients candidate for lung cancer resection. It does so by a literature search of clinical guidelines, expert consensus statements, meta-analyses, clinical recommendations, book chapters and randomized trials (1980-2022).

Depicting and predicting changes of lung after lobectomy for cancer by using CT images

Lobectomy is an effective and well-established therapy for localized lung cancer. This study aimed to assess the lung and lobe change after lobectomy and predict the postoperative lung volume. The study included 135 lung cancer patients from two hospitals who underwent lobectomy (32, right upper lobectomy (RUL); 31, right middle lobectomy (RML); 24, right lower lobectomy (RLL); 26, left upper lobectomy (LUL); 22, left lower lobectomy (LLL)). We initially employ a convolutional neural network model (nnU-Net) for automatically segmenting pulmonary lobes. Subsequently, we assess the volume, effective lung volume (ELV), and attenuation distribution for each lobe as well as the entire lung, before and after lobectomy. Ultimately, we formulate a machine learning model, incorporating linear regression (LR) and multi-layer perceptron (MLP) methods, to predict the postoperative lung volume. Due to the physiological compensation, the decreased TLV is about 10.73%, 8.12%, 13.46%, 11.47%, and 12.03% for the RUL, RML, RLL, LUL, and LLL, respectively. The attenuation distribution in each lobe changed little for all types of lobectomy. LR and MLP models achieved a mean absolute percentage error of 9.8% and 14.2%, respectively. Radiological findings and a predictive model of postoperative lung volume might help plan the lobectomy and improve the prognosis.

Predictive factors inhibiting recovery of the respiratory function after anatomical pulmonary resection

PURPOSE

Some patients have worse actual observed postoperative (apo) respiratory function values than predicted postoperative (ppo) values. The present study therefore clarified the predictive factors that hinder the recovery of the postoperative respiratory function.

METHODS

This study enrolled 255 patients who underwent anatomical pulmonary resection for lung cancer. A pulmonary function test (PFT) was carried out before surgery and at one, three, and six months after surgery. In each surgical procedures, the forced expiratory volume in 1 s (FEV1) ratio was calculated as the apo value divided by the ppo value. In addition, we investigated the predictive factors that inhibited postoperative respiratory function improvement in patients with an FEV1 ratio < 1.0 at 6 months after surgery.

RESULTS

The FEV1 ratio gradually improved over time in all surgical procedures. However, 49 of 196 patients who underwent a PFT at 6 months after surgery had an FEV1 ratio < 1.0. In a multivariate analysis, right side, upper lobe, segmentectomy and pleurodesis for prolonged air leakage were independent significant predictors of a decreased FEV1 ratio (p = 0.003, 0.006, 0.001, and 0.009, respectively).

CONCLUSION

Pleurodesis was the only controllable factor that might help preserve the postoperative respiratory function. Thus, the intraoperative management of air leakage is important.

Recovery of respiratory muscle strength, physical function, and dyspnoea after lobectomy in lung cancer patients undergoing pulmonary rehabilitation: A retrospective study

OBJECTIVE

To characterise changes in respiratory muscle strength, physical function, and dyspnoea in patients who underwent pre- and post-operative exercise intervention following lobectomy for non-small-cell lung cancer (NSCLC).

METHODS

This retrospective study included NSCLC patients who underwent lobectomy via video-assisted thoracoscopic surgery (VATS) or posterolateral thoracotomy (PLT) and pre- and post-operative exercise intervention consisting of breathing, flexibility, resistance, aerobic exercises, coughing/huffing techniques, and early mobilisation. Maximum mouth inspiratory (Pimax) and expiratory pressures (Pemax), 6-min walk distance (6MWD), quadriceps force (QF), and modified Medical Research Council (mMRC) dyspnoea scale were evaluated preoperatively, at hospital discharge, and post-lobectomy 1 and 3 months.

RESULTS

Data from 41 patients were analysed. At hospital discharge, the Pimax, Pemax, 6MWD, and mMRC dyspnoea scores were lower than pre-operatively; QF remained unchanged; Pimax and 6MWD recovered to pre-operative values at post-lobectomy 1 month; and Pemax and mMRC dyspnoea scores recovered at 3 months. During sub-analysis, Pimax and mMRC dyspnoea scores in the VATS (n = 24) and PLT groups (n = 17) recovered to pre-operative values at post-lobectomy 1 and 3 months.

CONCLUSION

After lobectomy, respiratory muscle strength, physical function, and dyspnoea in patients who underwent exercise intervention returned to pre-operative values at post-lobectomy 3 months.

Rapid Recovery of Postoperative Pulmonary Function in Patients With Lung Cancer and Influencing Factors

Among malignant tumors, lung cancer has the highest morbidity and mortality worldwide. Surgery is the first-line treatment for early-stage lung cancers, and has gradually advanced from conventional open-chest surgery to video-assisted thoracic surgery (VATS). Additionally, increasingly smaller surgical incisions and less surgical trauma have resulted in reduced pulmonary function damage. Previous studies have found that the level of pulmonary function loss and recovery is significantly correlated with postoperative complications and the quality of life. Thus, an accurate assessment of the preoperative pulmonary function and effective rehabilitation of postoperative pulmonary function are highly important for patients undergoing lung surgery. In addition, pulmonary function assessment after pulmonary rehabilitation serves as an objective indicator of the postoperative pulmonary rehabilitation status and is crucial to facilitating pulmonary function recovery. Furthermore, a complete preoperative assessment and effective rehabilitation are especially critical in elderly patients with pulmonary tumors, poor basic physiological functions, comorbid lung diseases, and other underlying diseases. In this review, we summarize the clinical significance of pulmonary function assessment in patients undergoing lung cancer surgery, postoperative changes in pulmonary function, effective pulmonary function rehabilitation, and the influencing factors of pulmonary function rehabilitation.

Effects of preoperative pulmonary function on short-term outcomes and overall survival after video-assisted thoracic surgery lobectomy

Background

Preoperative pulmonary function tests are a necessary preoperative assessment tool for non-small cell lung cancer (NSCLC) patients awaiting surgery. We studied the effects of preoperative pulmonary function on short-term outcomes and overall survival (OS).

Methods

A retrospective cohort study was undertaken with adult NSCLC patients undergoing video-assisted thoracoscopic surgery (VATS) lobectomy between May 2016 and April 2017. The primary exposure variables were the percentage of predicted peak expiratory flow (PEF%), the percentage of predicted forced vital capacity (FVC%), and the percentage of predicted forced expiratory volume in 1 s. The observation outcomes were postoperative pulmonary complications (PPCs), acute kidney injury (AKI), in-hospital mortality, readmission within 30 days, and OS. Univariate and multivariate analyses were performed.

Results

Of the 548 patients, postoperative pneumonia was observed in 206 (37.6%). The results of the binary logistics regression analysis showed that relative to the moderate PEF% group, the risk of postoperative pneumonia was significantly increased in the marginal PEF% [odds ratio (OR) 2.076; 95% confidence interval (CI): 1.211–3.558; P=0.008] and excellent PEF% (OR 1.962; 95% CI: 1.129–3.411; P=0.017) groups. Relative to the good FVC% group, the risk of postoperative pneumonia was significantly increased in the marginal FVC% (OR 2.125; 95% CI: 1.226–3.683; P=0.007) and moderate FVC% (OR 2.230; 95% CI: 1.298–3.832; P=0.004) groups. The OS analysis did not reveal any correlations among the pulmonary function parameters and OS in this cohort.

Conclusions

Preoperative PEF% and FVC% are associated with postoperative pneumonia in NSCLC patients undergoing VATS lobectomy. Preoperative PEF% is as important as FVC% in pulmonary function assessment before lung surgery.

A Modified Calculation Improves the Accuracy of Predicted Postoperative Lung Function Values in Lung Cancer Patients

PURPOSE

Preoperative pulmonary function testing is mandatory for non-small cell lung cancer (NSCLC) surgery. The predicted postoperative FEV1 (ppoFEV1) is used for further risk stratification. We compared the ppoFEV1 with the postoperative FEV1 (postFEV1) in order to improve the calculation of the ppoFEV1.

METHODS

87 patients voluntarily received an FEV1 assessment 1 year after surgery. ppoFEV1 was calculated according to the Brunelli calculation. Baseline characteristics and surgical procedure were compared in a uni- and multivariate analysis between different accuracy levels of the ppoFEV1. Parameters which remained significant in the multinominal regression analysis were evaluated for a modification of the ppoFEV1 calculation.

RESULTS

Independent factors for a more inaccurate ppoFEV1 were preoperative active smoking (odds ratio (OR) 4.1, confidence interval (CI) 3.6-6.41; p = 0.01), packyears (OR 4.1, CI 3.6-6.41; p = 0.008), younger age (OR 1.1, CI 1.01-1.12; p = 0.03), and patients undergoing pneumectomy (OR 5.55, CI 1.35-23.6; p = 0.01). For the customized ppoFEV1 we excluded pneumonectomies. For patients < 60 years, an additional lung segment was added to the calculation. ppoFEV1 = preFEV1 × [Formula: see text]. For actively smoking patients with more than 30 packyears we subtracted one lung segment from the calculation ppoFEV1 = PreFEV1 × [Formula: see text].

CONCLUSION

We were able to enhance the predictability of the ppoFEV1 with modifications. The modified ppoFEV1 (1.828 l ± 0.479 l) closely approximates the postFEV1 of 1.823 l ± 0.476 l, (0.27%) while the original ppoFEV1 calculation is at 1.78 l ± 0.53 (2.19%). However, if patients require pneumectomy, more complex techniques to determine the ppoFEV1 should be included to stratify risk.

Measured versus predicted postoperative pulmonary function at repeated times up to 1 year after lobectomy

OBJECTIVES

Postoperative pulmonary function is difficult to predict accurately, because it changes from the time of the operation and is also affected by various factors. The objective of this study was to assess the accuracy of predicted postoperative forced expiratory volume in 1 s (FEV1) at different postoperative times after lobectomy.

METHODS

This retrospective study enrolled 104 patients who underwent lobectomy by video-assisted thoracic surgery. Pulmonary function tests were performed preoperatively and postoperatively at 3, 6 and 12 months. We investigated time-dependent changes in FEV1. In addition, the ratio of measured to predicted postoperative FEV1 calculated by the subsegmental method was evaluated to identify the factors associated with variations in postoperative FEV1.

RESULTS

Compared with the predicted postoperative FEV1, the measured postoperative FEV1 was 8% higher at 3 months, 11% higher at 6 months and 13% higher at 12 months. The measured postoperative FEV1 significantly increased from 3 to 6 months (P = 0.002) and from 6 to 12 months (P = 0.015) after lobectomy resected lobe, smoking history and body mass index were significant factors associated with the ratio of measured to predicted postoperative FEV1 at 12 months (P < 0.001, P = 0.036 and P = 0.025, respectively).

CONCLUSIONS

Postoperative FEV1 increased up to 12 months after lobectomy by video-assisted thoracic surgery. The predicted postoperative pulmonary function was underestimated after 3 months, particularly after lower lobectomy.

A preliminary study identifies early postoperative lung volume changes in patients with non-small cell lung cancer following video-assisted thoracic surgery using CT volumetry

The present study aimed to investigate the changes in early postoperative lung volume in patients with non-small cell lung cancer (NSCLC) following video-assisted thoracic surgery (VATS) and to analyze the effects of the clinical characteristics on the lung volume of the patients. Therefore, 38 patients with NSCLC, who planned to undergo VATS at the Department of Thoracic Surgery, The Affiliated Hospital of Guizhou Medical University in June 2019, were enrolled into the present study. The clinical and computed tomography (CT) scan data from the patients was prospectively collected within 1 week preoperatively, and at 1, 3 and 6 months following surgery, then subsequently analyzed. A total of 34 patients successfully completed follow-up and were included in the datasets. The results showed that the volume of the right lung was larger compared with that in the left one, at each observational time point. The whole, right and left lung held the same trendline of volume changes, which was sharply decreased during the first postoperative month, increased quickly over the next 3 months, and slowly increased from months 3 to 6. There were 7 patients, whose whole lung volume was increased at 6 months following surgery compared with that preoperatively. In addition, significant differences were observed between males and females in the whole, right and left lung volume. However, the differences on the postoperative net expansion volume of the whole lung were not significant among sex, age, body mass index (BMI), smoking status and surgical side subgroups. The early changes of the postoperative lung volume were not linear, since the lung volume was significantly reduced during the first postoperative month, quickly increased in the next 3 months, and slowly increased from months 3 to 6. Sex, age, BMI, smoking status and surgical sides was not found to affect the postoperative volume and net expansion of the whole lung following VATS lobectomy.

Quality of Life After Stereotactic Body Radiation therapy Versus Video-Assisted Thoracic Surgery in Early stage Non-small Cell Lung Cancer. Is there Enough Data to Make a Recommendation?

BACKGROUND AND AIM

Health reported quality of life test (HRQOLT) in oncologic patients has become a major concern. Early stage in non-small cell lung cancer has two options for treatment in fragile population: Stereotactic body radiation therapy (SBRT) and video-assisted thoracic surgery (VATS). Which option should be recommended in daily clinical practice remains a challenging question. The current review is addressing this concern. Among 1256 articles, 19 met the inclusion criteria and 2034 patients were analyzed treated either with VATS or SBRT. Eleven manuscripts in SBRT, five VATS studies, and three reviews were summarized in the present review. In fragile population, SBRT seems to be a valuable option of treatment with minor or no changes in HRQOLT. However, baseline quality of life status or geriatric assessment tools before treatment could be a good strategy to select appropriate population for undergoing SBRT or surgery.

RELEVANCE FOR PATIENTS

In this paper, we present a systematic review where we compare the current evidence of two options for treatment in fragile population: SBRT and VATS.

Forced oscillation measurements in patients after lobectomy - A comparative analysis with IPF and COPD patients

OBJECTIVES

Forced oscillation technique (FOT) is becoming increasingly widespread measurement method used for assessment of lung function. In the present study, we attempted to assess FOT values in patients after lobectomy in comparison with IPF and COPD patients.

METHODS

Twenty-two patients after lobectomy due to lung cancer stage I or II, 28 patients with idiopathic pulmonary fibrosis and 17 patients with chronic obstructive pulmonary disease were enrolled in the study. All patients performed spirometry (FEV₁ , FVC, FEV₁ /FVC, MEF₅₀ , MEF₂₅ , FEF_25-75 , MIF₅₀ ), plethysmography (R_aw , TLC, RV, RV/TLC) and a test using the forced oscillation technique- resistance (R at 5Hz, 11Hz and 19Hz, inspiratory, expiratory and total), reactance (Xat 5Hz, 11Hz, inspiratory, expiratory and total), Fres and expiratory flow limitation (∆X). The ANOVA Kruskal-Wallis test followed by a multiple comparison test were used to evaluate the differences in oscillatory parameters between-groups.

RESULTS

Patients after lobectomy presented reduced X5, X11 and moderately increased R5, R11, R19, R5-19, ∆X and Fres. R_insp 5 weresignificantly higher when compared with IPF patients (P = 0.001). In lobectomy patients R5, X5, X11, ∆X and Fres were significantly less affected when compared with patients with COPD (P < 0.05 for all values). R5-19, which reflects small airways dysfunction, occurred to be similarly elevated as in COPD patients (0.5 vs 0.6 cmH₂ O/L/s).Abnormalities of reactance at 11Hz were observed more frequently than at 5Hz in all groups of patients.

CONCLUSION

Patients after lobectomy due to lung cancer presented FOT abnormalities, which could be caused by lung parenchymal abnormalities following recent thoracic surgery.

Comparison between quantitative computed tomography, scintigraphy, and anatomical methods for prediction of postoperative FEV1 and DLCO: effects of chronic obstructive pulmonary disease status and resected lobes

Background

Postoperative assessment of pulmonary function is important for estimating the risk of thoracic surgery and long-term disability following pulmonary resection, including predicted postoperative (ppo) forced expiratory volume (FEV) in one second (ppoFEV₁) and percent predicted lung diffusion capacity for carbon monoxide (ppo%DLCO) estimation. The ppo values were compared using four different estimation methods between chronic obstructive pulmonary disease (COPD) and non-COPD patients and according to the resected lobe.

Methods

This prospective study included 59 eligible patients requiring single lobectomy and succeeded in performing pulmonary function tests at 3 and 12 months after lobectomy. The ppoFEV₁ and ppo%DLCO were compared with poFEV₁ and po%DLCO obtained at 3 and 12 months after lobectomy. The ppo values were estimated using the four usual methods: the 19-segment anatomical technique (S), perfusion scintigraphy (Q), quantitative CT (CT), and quantitative CT with low attenuation volume (CT_LAV) subtraction.

Results

For non-COPD and COPD patients, the smallest mean difference between ppo and po values was observed by S for FEV₁ and %DLCO. Based on the resected lobe, the smallest mean difference was observed by (I) Q for right upper lobectomy (RUL) excluding %DLCO at 12 months by S, (II) S for left upper lobectomy (LUL), (III) CT and CT_LAV for right lower lobectomy (RLL), and (IV) CT and CT_LAV for left lower lobectomy (LLL) at 12 months. The ppo values calculated by S for RUL (FEV₁ at 3 and 12 months and %DLCO at 3 months) and by all four methods for LLL (FEV₁ and %DLCO at 3 months) were smaller than the po values.

Conclusions

The S method is adequate for calculating ppoFEV₁ and ppo%DLCO when patients are classified as non-COPD and COPD. However, S sometimes overestimates the ppoFEV₁ and ppo%DLCO when patients are classified according to the resected lobe. The CT_LAV method may be the method of choice instead of S for calculating ppoFEV₁ and ppo%DLCO in patients who undergo lung lobectomy despite the presence or absence of airflow limitation.